Treatment
Bowen’s disease must be treated to prevent development of a full blown squamous cell carcinoma. The present day treatment for Bowen’s diseases includes:
Surgical excision involves removal of the entire skin lesion. Depending on the size, most lesions are removed under local anesthesia. Because Bowen’s disease has a habit of developing near critical parts of the face such as the lip or near the eyes, the procedure is best done by a surgeon skilled in micro-reconstruction and maintaining your cosmesis. Because the lesion is cancerous, removal of normal healthy tissues is necessary.
Electrodessication is technique where the tumor is heated with a diathermy probe. The procedure is best for the most superficial small lesions. Once the tumor is destroyed with the heated needle, the lesion is then scrapped off. Electrodessication is excellent for the primary small tumors but does not work well for recurrent Bowen’s disease.
Cryotherapy is also widely used to treat small superficial Bowen’s disease. The treatment is generally painless and involves application of liquid nitrogen on the tumor. The cancer cells are killed instantly. Most patients require several sessions of Cryotherapy.
Moh’s surgery is probably the best treatment for Bowen’s disease. The technique is performed by select physicians who have been trained in this technique. The procedure essentially involves shaving off a few layers of the lesion and examining them under a microscope. The process is repeated until no more cancer cells are visible. The technique prevents unnecessary removal of healthy tissues.
Radiation is not a common treatment for Bowen’s disease. It is often administered to individuals who are too ill to undergo surgery or have multiple large skin lesions.
Another recent therapy is the use of photodynamic therapy. The treatment involves taking a drug which is very light sensitive. The drug then accumulates in the cancer cells and light is administered. The bright light causes destruction of all cancer cells which take up the drug.
Topical medications are now available which can be applied onto Bowen’s disease. These topical medications like Efudex cream, 5 Fluouracil, and Imiquimod , are available via a prescription and useful for very superficial Bowen’s disease. They may have a role when the Bowen’s disease is growing close to delicate structures of the face. These topical medications work by irritating and killing the tumor cells. However, the role of topical treatments is not widely accepted and needs to be done under the guidance of a dermatologist.
Any patient who has been diagnosed with Bowen’s disease should understand that this is an early form of cancer. If Bowen’s disease is not treated, it will develop into a full blown Squamous cell carcinoma. When the Bowen’s disease is treated, the prognosis is excellent.
Prevention
Like all skin cancers, Bowen’s disease can be prevented by undertaking the following steps:
Excessive exposure to sun must be avoided if one wants to prevent Bowen’s disease. Sun is always strongest in intensity from 10 am to 3 pm and one should avoid going out during this time period. Unless one has a job which requires going out during this time period, all outdoor activities should be scheduled outside these hours.
Sunscreens are a must for individuals who seek the sun. There are broad spectrum sun screens available today that can block out most UV rays of the sun. A sunscreen with a SPF of at least 20 is recommended. The sunscreen should be applied about 30 minutes prior to going out and then reapplied every 2-3 hours. The sunscreen should be reapplied after a swim or exercise. However, one should never rely on sun screen as the only measure of preventing skin cancer.
Because there is no sunscreen which can completely protect against skin cancer, it is highly recommended that one wear appropriate clothing. Besides a hat and sunglasses, one should wear protective clothing. Today, there are fabrics which have been designed to block UV rays of the sun.
There are many medications which can cause adverse skin reactions when exposed to sunlight. Speak to your health care worker about the side effects of any medications that you are taking. If you do take a medication that can cause phototoxicity, avoid going out in the sun.
If you have had a history of Bowen’s disease then it is imperative that you get regular check ups from a health care worker. It is essential to have all the sun exposed areas checked at least once a year.
References
Arbesman H, Ransohoff DF. Is Bowen’s disease a predictor for the development of internal malignancy? A methodological critique of the literature. JAMA. Jan 23- 30 1987;257(4):516-8.
Bargman H, Hochman J. Topical treatment of Bowen’s disease with 5-Fluorouracil. J Cutan Med Surg. Mar-Apr 2003;7(2):101-5.
Cox NH, Eedy DJ, Morton CA. Guidelines for management of Bowen’s disease: 2006 update. Br J Dermatol. Jan 2007;156(1):11-21.
Jones CM, Mang T, Cooper M, Wilson BD, Stoll HL Jr. Photodynamic therapy in the treatment of Bowen’s disease. J Am Acad Dermatol. Dec 1992;27(6 Pt 1):979-82. .
Leibovitch I, Huilgol SC, Selva D, Richards S, Paver R. Cutaneous squamous carcinoma in situ (Bowen’s disease): treatment with Mohs micrographic surgery. J Am Acad Dermatol. Jun 2005;52(6):997-1002.
Mackenzie-Wood A, Kossard S, de Launey J, Wilkinson B, Owens ML. Imiquimod 5% cream in the treatment of Bowen’s disease. J Am Acad Dermatol. Mar 2001;44(3):462-70.
Reference:
- Arbesman H, Ransohoff DF. Is Bowen’s disease a predictor for the development of internal malignancy? A methodological critique of the literature. JAMA. Jan 23- 30 1987;257(4):516-8.
