Bowen's disease, also known as squamous cell carcinoma in situ, is a type of skin cancer confined to the epidermis. Although it grows slowly, approximately 3%–5% of cases can progress to invasive squamous cell carcinoma if left untreated. Early detection is crucial for preventing complications and ensuring effective treatment. The IBOOLO dermatoscope provide a clear field of view with 10X magnification, magnifying Bowen's disease lesions. Physicians can recognize details that may have been missed by the naked eye.
What Is Bowen's Disease?
Bowen's disease typically presents as a red, scaly patch that may resemble more benign conditions like eczema or psoriasis. It can occur singly or multiply, often on sun-exposed areas such as the face, neck, and lower legs. The lesion's borders are usually irregular and slightly raised. In terms of pigmentation, it can range from pink to red-brown. The surface is typically scaly or crusted.
Bowen's disease is associated with prolonged UV radiation exposure and is more common in fair-skinned individuals. It can also arise from pre-existing actinic keratosis. Clinically, it is important to differentiate Bowen's disease from other skin conditions like actinic keratosis, psoriasis, eczema, and squamous cell carcinoma in situ. Dermatoscopy plays a vital role in this differentiation.
How Can Dermatoscopy Help Detect Bowen's Disease?
Dermatoscopy relies on magnification and illumination to enhance the visibility of skin lesions. When using a dermatoscope, clinicians apply a small amount of liquid to the lesion to reduce surface reflection and then examine it under magnification. However, if you are using an IBOOLO dermatoscope, you can hold the dermatoscope directly against your skin to observe without applying liquid.
For Bowen's disease, typical dermatoscopic features include glomerular vessels, which are small, rounded blood vessels within the lesion. These vessels are more prominent in polarized mode and correspond to dilated and tortuous vessels in the superficial papillary dermis. The surface of the lesion often appears scaly, with a white-yellow keratin layer and erythema. In pigmented Bowen's disease, additional features such as brown globules and gray-to-brown homogeneous pigmentation may be observed. Dermatoscopy helps clinicians identify these specific features, especially under amber light. Amber light is utilized to improve the distinction between the skins surface and deeper layers for images when evaluating color inconsistencies and pigmentation on the skin.
What Are the Dermatoscopic Features of Bowen's Disease?
The most typical dermatoscopic features of Bowen's disease include glomerular vessels and a scaly surface. Glomerular vessels are often grouped in clusters and surrounded by a white halo, indicative of keratinization. The surface scales are also a key feature. Pigmented Bowen's disease may show regularly packed brown globules in a patchy distribution and gray-to-brown homogeneous pigmentation. White rosettes may also be observed due to the optical interaction of polarized light with the skin around follicular infundibulae. Dermatoscopy can thus be highly useful for diagnosing Bowen's disease due to these specific morphological features.
How Can We Differentiate Bowen's Disease from Similar Conditions Using Dermatoscopy?
Dermatoscopy is invaluable for differentiating Bowen's disease from other skin lesions. For example, actinic keratosis may present with redness, scale, and a rough texture. Under dermatoscopy, it may show erythema, a red pseudonetwork, a strawberry pattern, and rosettes. Invasive squamous cell carcinoma may exhibit hairpin vessels, irregular linear vessels, and white structureless areas. Basal cell carcinoma often reveals arborizing vessels, short fine telangiectasia, ulceration, blue-ovoid nests, and shiny white-red structures. Malignant melanoma may display asymmetry, irregular borders, and varied colors. By comparing these features with those of Bowen's disease, such as glomerular vessels and specific scale patterns, clinicians can make more accurate diagnoses.
How Can Bowen's Disease Be Treated and Managed?
Treatment options for Bowen's disease depend on factors such as the size, location, and thickness of the lesion, as well as the patient's overall health and preferences. Surgical excision involves cutting out the lesion and a small margin of healthy tissue around it and is highly effective for lesions with defined borders. Curettage and electrodessication is another option where the lesion is scraped off and then cauterized. Cryotherapy uses extremely cold temperatures to freeze and destroy the abnormal skin cells. Photodynamic therapy combines a photosensitizing agent and light exposure to eliminate the lesion. Topical medications such as 5-fluorouracil cream or imiquimod cream may also be considered. After treatment, proper wound care and regular follow-up appointments are essential. During follow-ups, healthcare professionals can use dermatoscopes to closely inspect the skin for any abnormalities. Patients should also be educated about skin self-examination and advised to protect their skin from excessive UV radiation.
Dermatoscopy is instrumental in early detection during these screenings, allowing clinicians to closely examine skin lesions and identify potential Bowen's disease at an early stage when treatment is most effective. Early and correct diagnosis and treatment of Bowen's disease are of great importance as they prevent the transformation into invasive squamous cell carcinoma.