There are many types of skin cancers. One of these is Bowen's disease, which was described by an American dermatologist and named after him.
Pathology is a squamous cell carcinoma that is in one place and tends to grow to the periphery. The foci of the disease can reach several centimeters in size. Carcinomas are painless and may develop plaques or scaly surfaces.
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 the degeneration of malignant cells, namely keratinocytes. Such a skin pathology is considered a harbinger of cancer. Some experts even refer to it as an early stage of cancer.
Reasons for appearance
The exact reasons why Bowen's disease occurs have not yet been established. However, it is known for certain that the process of cell degeneration is affected byexposure 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, among other risk factors, long-term exposure to arsenic is cited. Hydrocarbons and mustard gas also play a role in the development of Bowen's disease (in men more often than in women).
Unfavorable external influences on the superficial 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, spiny layer of the epidermis falls under the influence, its cells begin to change and divide abnormally.
As long as the neoplasm does not pass 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. Metastasis in this case is excluded, although the formation is considered malignant.
Symptoms of Bowen's disease
A photo of the external manifestations of the disease is presented later in the article. The main symptom of the disease are reddish-brown spots on the skin, growing from the center to the periphery. The spots have clear borders and raised annular edges. In some cases, the foci look likescaly areas of the skin. The formations are flat, with raised edges, oval or rounded in shape with regular outlines. Sometimes these skin lesions can cause itching, but most often they are painless. In the future, ichor or pus may begin to stand out from them, and crusts may also form. Small growths stand out on the granular and uneven surface of the focus of the disease.
Bowen's disease in women can look like a warty growth 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 erosions form, which gradually heal and scar, increasing in size and affecting an increasing surface of the skin.
Most often the symptoms of Bowen's disease appear on areas of the skin that are open, but sometimes there is localization of the pathology on the palms, feet and genitals. It also happens that the disease is localized in the oral cavity, and in this case it definitely refers to a precancerous condition, since there is a high probability of malignancy. Lips and gums may also be affected.
Diagnosis
If the doctor suspects Bowen's disease in a patient, it is necessary to determine the presence of external signs of the disease, as well as carefully collect an anamnesis. It is necessary to conduct a differential diagnosis, since the pathology is similar to many dermatological diseases.symptoms. Sometimes patients do not immediately notice the problem, since the spots formed on the skin do not cause discomfort. For this reason, a careful examination of the patient is considered an important step in the diagnosis.
In addition, a piece of the affected tissue is taken for a biopsy. This study will exclude other diagnosis options and confirm Bowen's disease in women and men (the photo shows what the pathology may look like). Without a biopsy, it is impossible to accurately determine the risk of damage and choose treatment methods.
What draws attention to
When examining damaged tissue, the specialist pays attention to the following signs:
- Acanthosis with elongated and thickened outgrowths.
- Skin surface keratinization.
- Paraketosis of focal type.
- Disordered spiny cells.
- Large brightly colored nuclei and atypia.
- Cellular vacuolization.
- Mitotic figures.
When a disease progresses to a cancerous stage, the following changes occur:
- Destruction of the basal containment.
- A sharp change in the shape of cells with acantholysis immersing deep into the dermis.
Treatment of Bowen's disease
So far no standard treatment regimen has been found for the pathology. Therapy is selected individually, depending on the location of the disease, the age of the patient, the number and size of lesions, the state of human he alth and other indicators. Oftentherapeutic methods are combined.
Patients diagnosed with Bowen's disease are offered a variety of treatments:
- Cryotherapy.
- Chemotherapy.
- Photodynamic therapy.
- Electrodestruction.
- 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 drawn up for each patient.
In some cases, the specialist makes a choice in favor of expectant tactics. This occurs if the patient is elderly or the disease is localized on the limbs, in places that can be sheltered from sun exposure. The patient is advised to visit a specialist regularly, and at the first symptoms of progression of education, surgical intervention 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.
- Chemotherapeutic drugs are used to destroy tumor cells. 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. Up to 6 courses of treatment are carried out in this way.
- Surgical intervention. This is the most effective treatmentsince malignant neoplasm cells do not metastasize and are located on the surface of the skin without penetrating too deeply. The operation is performed under 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 slight effect on he althy tissues surrounding the lesion. After the treatment, the tissues freeze and form a crust, which disappears after a few weeks. The method is suitable for single formations at the initial stage.
- Phototherapy. 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 further exposing them to light irradiation. Cells that have absorbed the photosensitizer from the cream die. The cream is applied 4-6 hours before the irradiation procedure. Requires multiple sessions to heal.
- Radiation therapy. Previously, this method was widely used, but today, safer methods are preferred. After radiation therapy, poorly overgrown skin lesions are formed. As a rule, this technique is used if it is not possible to perform a surgical intervention.
- Laser therapy. This method is not widely used. However, he showedsome positive results. A number of studies are needed to evaluate the effectiveness of this method.
We looked at the treatment of Bowen's disease. We will consider the forecast in the next section.
Prognosis for this disease
With this disease, especially under the condition of timely therapy, a favorable prognosis is given. When the focus of the disease is removed, the patient can be considered completely he althy. The risk of degeneration of education on the skin into an invasive form of cancer reaches 3-5%.
The probability of such a rebirth increases to 10% with localization in the genital area or Keyr's erythroplasia. Some scientists, however, believe that transformation into cancer occurs in 80% of cases. These discrepancies indicate differences in climatic conditions, intensity of exposure to sunlight and detection of the disease in different countries.
When the diagnosis is accurately established, the best option is to remove the neoplasm with a medical or surgical method. This will keep the patient safe and reduce the risk of cancer.
How to determine the beginning of the transformation?
There are a number of signs by which you can determine the beginning of the transformation of Bowen's disease into cancer:
- Bleeding.
- Formation of a bump in the affected area.
- Ulceration.
- Swollen lymph nodes.
- Skin tightening.
- Change in the color of affected skin.
The appearance of the above symptoms indicates the needsee a doctor urgently before metastasis occurs and cancer cells begin to spread throughout the body.
Prevention
Successfully cured patients are advised to avoid sun exposure, wear wide-brimmed hats, use sunscreen and wear long sleeves and pants. Timely treatment and preventive measures prescribed by specialists reduce the risk of recurrent lesions.
