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IEC or Bowen’s disease

IEC stands for intra-epidermal carcinoma, or Bowen’s disease. This is a very common form of skin cancer diagnosed in Brisbane. This cancer is commonly located on sun-exposed areas, such as the ears, nose, face, hands and lower legs. IEC or Bownes disease skin cancers present as red, persistent and often scaly patches. This form of skin cancer responds well to non-surgical methods of treatment, such as Photodynamic Therapy.

Important facts on IECs or Bowen’s disease

  • IECs are common skin cancers
  • If left untreated they can transform into the more serious squamous cell carcinoma (SCC) variety
  • This form of skin cancer is related to UV exposure, hence it is more common in the tropical cites such as Brisbane, Cairns and Townsville compared to persons residing in Sydney or Melbourne
  • IECs can be managed with liquid nitrogen spray, surgically, with creams and photodynamic therapy (PDT)
  • IECs on the lower legs are best managed with PDT, as healing after surgery can be slow in these areas
  • Patients with a history of IEC skin cancers should be followed up every 6 months by a skin cancer specialist, as they are at risk of developing more skin cancers

What does an IEC look like?

IEC or bowens diseaseIntra-epidermal cancers usually arise as irregular, flat, red and scaly patches of up to several centimetres in diameter. Although IEC may develop on any area of skin, they are most often diagnosed on sun exposed sites such as the ears, face, hands and the lower legs.

What are the risk factors for IEC skin cancers?

IEC skin-cancer-cureBy far the most common risk factor for IEC is frequent excess sun exposure.  Prior radiotherapy to the affected skin is a further risk factor as is previous exposure to the chemical arsenic, however, this remains a rare cause.  In those who have to take medications to lower their immunity (for example, people who have had an organ transplant) there exists an increased risk for developing IEC.  Occasionally, IEC can develop on the genital area and is usually linked with the human papilloma virus.

How do skin cancer doctors diagnose IEC or Bowen’s Disease?

diagnosing bowens diseaseIEC can be diagnosed by taking a small sample of the affected skin (biopsy). If you’re my Skin Cancer doctor suspects you may have an IEC he/she will use a local anaesthetic to numb the affected skin prior to performing a biopsy.  A pathologist will examine the sample of skin under a microscope to provide you with a diagnosis.

What other skin conditions resemble IECs?

IECs can be similar in appearance to several other skin conditions such as:

  • Actinic keratosis
  • Keratoacanthoma
  • Warts
  • Chondrodermatitisnodularishelicis
  • Basal cell carcinoma
  • Melanoma

What treatment options are there for IECs?

pdt for bowen'sThere are a number of different treatment options available for management of IEC. The type of treatment selected will depend on where the IEC is located, its size, thickness and how many there are.

 

Cryotherapy

Liquid nitrogen is sprayed on to the affected area to freeze it. This treatment is suitable for small, flat patches of IEC. After treatment, you will have a scab, which usually falls off within a few weeks. This removes the affected skin.

 

Creams (topical therapy)

A chemotherapy (anti-cancer treatment) cream called 5-fluorouracil (Efudix), may be used. Clinical studies have shown 5FU to be efficacious in clearing IEC with cure rates of 66-93% reported. Treatment appears to be most successful when Efudix is applied once or twice a day for 6-16 weeks.  It can make the skin red and inflamed following treatment. Usually there are no other side effects.

 

Another cream commonly used is Imiquimod (Aldara), which works by stimulating the immune system to kill the abnormal cells. Treatment takes several weeks and usually causes redness and inflammation to the treated skin

 

Curettage and Electrocautery

When small patches of IECs are present they may be scraped away (curettage) followed by the use of an electrically heated needle (electrocautery)to stop any bleeding and destroy any remaining abnormal cells. A local anaesthetic is given prior to the procedure to prevent pain and discomfort.

 

Surgery

Surgery may be used for isolated or small areas of IEC that can removed under local anaesthetic.

are carrying out research trials to find out how effective this treatment is in the long term.

 

Photodynamic therapy (PDT)

PDT or Photodynamic therapy can be an excellent method of treating skin cancers such as IECs or thin- superficial BCCs. This is a non-surgical treatment for skin cancer that has a very high cure rate, if performed in the correct setting.

PDT uses a special cream called METVIX, which is applied to the skin cancer. The cancerous cells of IECs and BCCs take up this chemical over a period of 3 hours. A special low level laser light then activates the chemical, and destroys the skin cancer cells. Patients will require two treatments spaced a week or two apart.

 

The advantages of PDT over surgery include-

  1. Less scarring
  2. Much less downtime, with minimal restrictions on daily activities of living

 

PDT is ideal for IECs on cosmetically sensitive areas such as the face, or for IECs that occur on the legs.

Read more about PDT for skin cancers

 

For those who have larger areas of skin affected by IECs, PDT can be very useful.  Clinical trials have shown cure rates from PDT to be to other conventional treatments such as cryotherapy or surgery. The benefit of PDT is that it selectively targets abnormal/cancer cells without affecting the normalhealthy cells therefore cosmetic outcomes are improved.

Can all IECs or Bowen’s disease be treated with PDT?

pdt for iecsNo. 95% of IECs can be treated with PDT, however IECs on the scalp or in the brow line will need to be treated with surgery. This is because skin cancer cells extend deep into the hair follicle in these areas, out of reach from PDT methods. Your Skin Cancer Doctor will guide you in regards to which skin cancers can benefit from PDT.

What is the prognosis of IEC or Bowen’s disease?

Irma SchmidtIt is possible for IECs to recur anywhere from months to years following treatment.  Should this occur, it is possible to treat the IEC using with either the same or a different form or treatment.

What follow up is recommended following treatment of IEC skin cancers?

People who have had IECs are at greater risk of developing other forms of skin cancer such as squamous cell carcinoma, basal cell carcinoma or melanoma.  It is therefore important for people treated for IEC to continue to have regular skin checks performed by their GP, My Skin Cancer doctor or Dermatologist.