How Bowen's Disease Is Treated

Bowen's disease is an early form of skin cancer that affects the outermost layer of the skin. The disease appears as patches of brownish or red scaly skin that may be itchy. The patches of skin are slow-growing and commonly appear in areas of the skin that receive the most sun exposure.

There are a number of treatment options for Bowen's disease, and treatment is often very successful and can even result in curing the condition. Treatment options include surgery, local nonsurgical treatments, and drugs.

You doctor will do a thorough examination of the affected skin areas to determine your next treatment option. Factors that influence which treatment is used include the number of affected skin patches, their size and thickness, and the state of the skin generally.

Surgery

Surgery is one of the most common treatments for Bowen's disease. 

There are a number of surgical techniques used in the treatment of Bowen's disease, and their use will vary based on:

• How large the affected patch of skin is
• Where the affected patch of skin is

Excision Surgery

This surgical technique is the most common treatment for Bowen's disease. During excision surgery, the skin is numbed using a local anesthetic. The doctor then cuts out the cancerous patch with a special kind of surgical knife. Typically, the skin that remains in the area is then stitched up. Excision surgery can be performed in a doctor's office or an outpatient facility. This surgery will leave a scar.

Mohs Surgery

Also called Mohs micrographic surgery or MMS, Mohs surgery is a surgical technique used if the extent of cancer is unknown, if there is a risk that skin cancer will return, or if the goal of surgery is to save as much healthy skin as possible. This surgery is also performed in delicate or sensitive areas like the fingers, ears, face, and near the eye.

During Mohs surgery, a specialist surgeon removes thin layers of skin and examines them under a microscope to check for skin cancer cells. As long as cancer cells are found, another thin layer of skin is removed and examined. This process is repeated until the skin layers being examined are free of cancer cells. This technique means that more healthy skin near the affected skin can be saved, improving the appearance following surgery.

Mohs surgery can take longer than other surgical techniques, but it often has better outcomes.

Curettage and Electrodesiccation

This is a surgical technique used in the treatment of skin cancers confined to the outermost layer of skin, like in Bowen's disease.

During curettage and electrodesiccation treatment, a doctor scrapes the affected area of skin with a surgical instrument called a curette. This is a long, thin tool with a sharp loop on the end. Once the affected skin has been scraped, an electric needle called an electrode is used to destroy cancerous skin cells that remain. This treatment can be performed in a doctor's office and may have to be repeated a few times during the same visit. The treatment will leave a scar. 

Local Nonsurgical Treatments

There are a number of nonsurgical options available in the treatment of Bowen's disease.

These include photodynamic therapy, cryotherapy, and laser surgery.

Photodynamic Therapy

Also called PDT, photodynamic therapy involves applying a special cream that is sensitive to light to the affected area of skin. A few hours after the cream has been applied, a special light is pointed at the affected area of skin, which kills the cancerous cells.

The treatment takes 20 to 45 minutes to complete and may require more than one treatment session.

Photodynamic therapy may make the skin swollen or red in the affected area. It can also increase the skin's sun sensitivity in the period following the procedure.

Cryotherapy/Cryosurgery

Cryotherapy or cryosurgery is a treatment in which liquid nitrogen is applied directly to the affected patch of skin to freeze the skin cancer cells and kill them.

This procedure can be performed in a doctor's office and may be repeated a few times a session.

Once the affected area of skin thaws following treatment, swelling will occur as well as blistering. The wound will then crust over. It may take a couple of weeks to months for the wound to heal, and there may be fluid draining from the wound during the healing process. Following treatment, the affected area may have less color than before.

Laser Surgery

Laser surgery involves focusing a beam of light on the affected area of skin to vaporize skin cancer cells. It is not a widely used treatment in Bowen's disease because the efficacy of the treatment remains unknown.

Topical Drugs

Drugs in the form of creams or ointments may be used in the treatment of Bowen's disease.

One such option is topical chemotherapy drugs. These drugs work by killing cancerous cells on the surface of the skin. The drugs are applied in a cream or ointment directly to the skin, and because of this localized treatment, they don't cause side effects in other parts of the body as seen in systemic chemotherapy.

A topical chemotherapy cream commonly used in Bowen's disease treatment is 5-fluorouracil (5-FU). This is usually applied to the affected area once or twice every day for a few weeks.

Imiquimod cream was originally used to treat genital warts but is also used to treat Bowen's disease. The cream works by triggering the immune system to respond to the affected area of the skin and destroy the skin cancer cells. It is applied a few times a week and is often used for affected skin patches on the lower legs.

Complementary and Alternative Medicine (CAM) and Lifestyle Changes

There are no home remedies that have been proven effective in the treatment of Bowen's disease. There also are no complementary or alternative therapies that have been proven to be effective.

There are a few steps people can take to prevent more patches of Bowen's disease from appearing.

These include:

• Limiting sun exposure
• Protecting the skin with clothing
• Wearing a hat that covers the scalp, face, neck, and ears
• Staying in the shade when the sun is at its strongest between 10 a.m. and 3 p.m.
• Using a sunscreen with an SPF of 30 or more
• Applying sunscreen at least 15 minutes before going in the sun
• Reapplying sunscreen regularly, especially when swimming

No Treatment

In some cases, a doctor will recommend that Bowen's disease be monitored closely rather than treated. This may be due to the patch of affected skin being in an area where the skin is too thin, or because the disease is viewed as being unlikely to progress or spread, causing further issues. In this case, a doctor will advise an appointment schedule to monitor the patches of affected skin regularly.

A Word From Verywell

Undergoing treatment for any kind of cancer can be worrisome, but remember that Bowen's disease is an early form of skin cancer. It is considered a minor condition and often is curable with proper treatment. Whether your doctor advises a type of surgery, a nonsurgical local treatment, or topical drugs, you will likely be able to be treated in the comfort of an outpatient doctor's office and your recovery time and scarring should be minimal.

If you have concerns about your treatment options, be sure to ask your doctor as many questions as you need to feel comfortable. Treating your Bowen's disease patches is the final step toward making a complete recovery.