There are many types of malignant tumors on the skin. One of these is Bowen's disease, which was described by a dermatologist from America and named after him.
Pathology is a squamous cell carcinoma, which is located in one place and tends to grow on the periphery. The foci of the disease can reach the size of several centimeters. Carcinomas are painless; plaques or flaky surfaces may form on their surface.
Localization of this pathology
Bowen's disease (photos of neoplasms are presented in the article) is initially localized in the surface layer of the skin, that is, the epidermis. It occurs against the background of degeneration of malignant cells, namely keratinocytes. Such a skin pathology is considered a harbinger of cancer. Some experts even attribute it to an early stage of cancer.
Reasons for the appearance
The exact reasons why Bowen's disease occurs have not yet been established. However, it is known for certain that the process of degeneration of cells is affected by exposure to sunlight. Old age is also a risk factor. Most often, the disease is diagnosed in people who take drugs that suppress the immune system, such as immunosuppressants, cytostatics, and glucocorticoids.
The likelihood of developing pathology increases in patients who are infected with the human papillomavirus, especially type 16. In addition, long-term exposure to arsenic is called among other risk factors. Hydrocarbons and mustard gas also play a role in the development of Bowen's disease (in men more often than in women) .
Adverse external influences on the surface skin cells disrupt metabolic processes, which accelerates their death. The resulting new cells change at the genetic level, which ultimately causes a violation of their functions and structure. Initially, the middle, spiky layer of the epidermis is affected, its cells begin to change and divide abnormally.
Until the neoplasm passes through the membrane that separates the middle layer of the skin and the epidermis, it is designated as a carcinoma enclosed in one place within the epithelium. In this case, metastasis is excluded, although the formation is considered malignant.
Symptoms of Bowen's Disease
Photos of the external manifestations of the disease are presented later in the article. The main symptom of the disease is reddish-brown spots on the skin, growing from the center to the periphery. The spots have clear boundaries and raised annular edges. In some cases, the foci look like flaky patches of skin. The formations are flat, with raised edges, oval or round in shape with the correct outlines. Sometimes such skin lesions can cause itching, but more often they are painless. In the future, they can begin to stand out an anemone or pus, as well as crusts. On the granular and uneven surface of the focus of the disease, small growths stand out.
Bowen's disease in women may resemble warty growths with cracked skin or hyperpigmentation. Most often, the focus of the disease is one, but in 15% of patients there is multiple localization.
When the disease progresses
When the disease progresses, ulcers and erosion are formed, which gradually heal and scarring, increasing in size and affecting an increasingly large surface of the skin.
The most common symptoms of Bowen's disease are manifested in areas of the skin that are open, however, localization of the pathology on the palms, feet, and genitals is sometimes found. It also happens that the disease is localized in the oral cavity, and in this case it definitely refers to the precancerous condition, since there is a high probability of malignancy. Damage to the lips and gums is also possible.
Diagnostics
If the doctor suggests that the patient has Bowen's disease, it is necessary to determine the presence of external signs of the disease, and also to carefully collect the anamnesis. It is necessary to conduct differential diagnosis, since the pathology has a symptomatology similar to that of many dermatological diseases. Sometimes patients do not immediately notice the problem, since the spots formed on the skin do not cause discomfort. For this reason, an important examination is considered a careful examination of the patient.
In addition, a piece of the affected tissue is taken for biopsy. This study will exclude other diagnosis options and confirm Bowen's disease in women and men (the photo shows how the pathology may look). Without a biopsy, it is impossible to accurately determine the risk of damage and choose treatment methods.
What attention is paid to
When conducting a study of damaged tissue, a specialist pays attention to the following symptoms:
- Acanthosis with the presence of elongated and thickened outgrowths.
- Keratinization of the skin surface.
- Focal type paraketosis.
- The disordered position of the prickly cells.
- Large brightly colored nuclei and atypia.
- Cell vacuolization.
- Mitous figures.
With the transition of the disease to the cancer stage, the following changes occur:
- Destruction of the basal protective sheath.
- A sharp change in the shape of cells with the immersion of acantholysis deep into the dermis.
Bowen Disease Treatment
No standard treatment regimen has yet been found. Therapy is selected individually, depending on the location of the disease, the age of the patient, the number and size of foci, human health and other indicators. Quite often, therapeutic methods are combined.
Patients diagnosed with Bowen's disease are offered various treatment methods:
- Cryotherapy
- Chemotherapy
- Photodynamic therapy.
- Electrodegradation.
- Surgical intervention.
It is quite difficult to predict which method will help a particular patient, although all of the above procedures are effective in themselves. For this reason, an individual therapy program is prepared for each patient.
In some cases, the specialist makes a choice in favor of expectant tactics. This happens if an elderly patient or disease is localized on the limbs, in places that can be protected from sun exposure. The patient is recommended to regularly visit a specialist, and with the first symptoms of progression of education, surgery is performed.
Description of therapeutic techniques
As mentioned above, there are a number of treatments for Bowen's disease. Some of them are listed below.
- To destroy tumor cells, chemotherapeutic drugs are used . These include Imiquimod and 5-Fluorouracil. Within a week, ointments with the same active ingredients are applied twice a day to the affected areas of the skin, then a break is taken for several days, and the course of treatment is repeated. Thus, up to 6 courses of treatment are carried out.
- Surgical intervention. This is the most effective method of treatment, since malignant cells of the neoplasm do not metastasize and are on the surface of the skin without penetrating too deeply. The operation is performed with local anesthesia.
- Curettage. It is a curettage with further electrocoagulation. Affected tissues are scraped off with a special tool, and then the focus of the disease is cauterized. In some cases, several sessions are necessary.
- Cryotherapy. This is a minimally invasive method of therapy, which consists in a minor effect on healthy tissues surrounding the lesion. Tissues after processing freeze and form a crust that disappears after a few weeks. The method is suitable for solitary formations at the initial stage.
- Phototherapy. It is used for large affected areas of the skin. The procedure consists in applying a special cream, which tends to accumulate in the affected cells, and subsequently exposing them to light exposure. Cells that have absorbed the photosensitizer from the cream die. The cream is applied 4-6 hours before the irradiation procedure. It takes several sessions to recover.
- Radiation therapy. Previously, this method was widely used, but today safer methods are preferred. After radiation therapy, poorly overgrowing skin lesions form. As a rule, this technique is used if surgical intervention is not possible.
- Laser Therapy This method is not widespread. However, he showed some positive results. A number of studies are needed to evaluate the effectiveness of this method.
We reviewed the treatment for Bowen's disease. We consider the forecast in the next section.
The prognosis for this disease
With this disease, especially under the condition of timely treatment, a favorable prognosis is given. When the focus of the disease is removed, the patient can be considered completely healthy. The risk of degeneration of the formation on the skin into an invasive form of cancer reaches 3-5%.
The likelihood of such a rebirth increases with localization in the genital area or Keir erythroplasia increases to 10% . Some scientists, however, believe that transformation into cancer occurs in 80% of cases. These discrepancies indicate differences in climatic conditions, the intensity of exposure to sunlight and the detection of disease in different countries.
When the diagnosis is accurately established, the most optimal option is to remove the neoplasm with a medical or surgical method. This will protect the patient and reduce the risk of cancer.
How to determine the beginning of a transformation?
There are a number of signs by which you can determine the onset of the transformation of Bowen's disease into cancer:
- Bleeding.
- The formation of bumps in the affected focus.
- Ulceration.
- Enlarged lymph nodes.
- Skin tightening.
- Discoloration of the affected skin.
The appearance of the above symptoms indicates the need to urgently consult a doctor until metastasis has occurred and cancer cells have not begun to spread throughout the body.
Prevention
Patients who have successfully recovered are advised to avoid exposure to the sun, wear hats with wide brim, use sunscreens and give preference to clothes with long sleeves and legs. Timely treatment and prophylaxis prescribed by specialists reduce the risk of developing repeated lesions.