Bowen disease
Bowen's disease is a type of skin cancer that specifically impacts the upper layer of the skin known as the epidermis. It is classified as a squamous cell carcinoma in situ. Chronic exposure to ultraviolet radiation, often from the sun, is a primary cause of these lesions. The areas most commonly affected by Bowen's disease are the head, neck, trunk, arms, and lower legs. If left untreated, Bowen's disease can advance and develop into invasive skin cancer known as squamous cell carcinoma (SCC).
Bowen's disease typically manifests as a persistent red, scaly patch that grows slowly and appears on areas of the skin that have been chronically exposed to the sun. Often, there are no accompanying symptoms, which can lead to a delay in seeking treatment. The condition may be mistaken for other skin conditions such as eczema, psoriasis, fungal infections (tinea), and a few others. The diagnosis is primarily made by a physician based on clinical examination, and in some cases, it may be confirmed through a biopsy.
In addition to ultraviolet radiation, there are several other potential causes of Bowen's disease, including:
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Immunosuppression: Individuals who have undergone organ transplantation, such as kidney, liver, or heart transplant patients, and are on immunosuppressive medications, may be at an increased risk.
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Arsenic exposure: Although rare nowadays, exposure to arsenic, a toxic element found in certain industrial settings or contaminated water sources, has been associated with Bowen's disease.
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Human papillomavirus infection (HPV): Certain types of HPV, particularly those associated with genital warts (such as HPV 16 and 18), have been linked to the development of Bowen's disease.
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Ionizing radiation: Prolonged exposure to ionizing radiation, such as in the context of previous radiation therapy for cancer treatment, may contribute to the development of Bowen's disease.
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Rare genetic disorders: In some cases, individuals with rare genetic disorders, such as xeroderma pigmentosum or epidermodysplasia verruciformis, may have an increased susceptibility to developing Bowen's disease. It's important to note that these factors are potential contributors, and the exact causes and mechanisms of Bowen's disease can vary.
Treatment options for Bowen's disease vary depending on factors such as the size and location of the lesion, the patient's age and overall health, cosmetic considerations, previous treatments attempted, and the cost and availability of treatment. Here are some common treatment options:
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Liquid nitrogen cryotherapy: The lesion is frozen using liquid nitrogen to destroy the abnormal cells.
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Surgical excision: The affected area is surgically removed along with a margin of healthy tissue to ensure complete removal.
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Curettage and electrocautery: The abnormal tissue is scraped off (curettage) and the remaining area is cauterized (electrocautery) to control bleeding and destroy any remaining abnormal cells.
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Photodynamic therapy: A light-sensitive medication is applied to the lesion, followed by exposure to a specific type of light that activates the medication to destroy the abnormal cells.
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Radiotherapy: High-energy X-rays or other forms of radiation are used to target and destroy the cancerous cells.
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Topical chemotherapy: Medications like 5-fluorouracil (Efudex), Imiquimod (Aldara, Zyclara), or Ingenol mebutate (Picato) are applied directly to the skin to kill the abnormal cells.
It's important to note that a small percentage of cases may experience recurrence even after treatment. Regular surveillance, sun protection, and avoidance measures are recommended to monitor for any potential recurrence and protect the skin from further damage.