Anyone with experience of Bowen’s carcinoma in situ please help

[Moises]

Hi All,

My cat (Penny) was diagnosed with Bowenoid in situ carcinoma last year by biopsy we remove 5 lesions. For the new one our vet prescribed Aldara (impossible to find in Uk, so we buy imunocare (Imiqimod also) in Spain in holiday).
We have been touching the cat and found another 10-15 new small lesions in a year, apply Imiqimod and go away the lesion.
But she has two remaining, one in the forehead and another one in the leg. These two has been there for over 3 or 4 months. Do you have any lesion in the cat this long time? I am worried about change to SCC and metastases.
How do you find new lesion? Do you shave the cat often or just touch smooth with the fingers trying to find something different in the skin?
In the head lesion she scratched and have a wound in the middle of the lesion difficult to heal because she keep tearing off the scab when scratching. Do you experience this case? Is possible laser or cryosurgery with a open wound or a scab in the bowenoid lesion?

How many new lesion do you find on average per year?
My vet doesn't know anything about this illness and she keep saying referral for oncologist. When I know I need a dermatologist.

Another thing, we have been applying the imiqimod cream for one year between different lesion with gap of a week sometimes. In the last two months she has some sneezing attacks and nasal discharge in one nostril most of the time. Have you had this side effects? Do you have any idea what can be? My vet dont recommended anything and just prescribed Bisolvon (a sachet).
Can be other illness? What do you recommend? We did blood test 6 months ago and come out fine but liver enzymes a bit high (vet said for the imiqimod cream is normal).

After lack of help from vet we are talking with a vet 300miles away which has cryosurgery and Laser, She said for both need anesthesia, but I read here B babiesmom5 apply cryotherapy all the time without anesthetic. How many sessions need for cryosurgery for one lesion? And how many for laser?

Any guidance or help is very appreciated. I cannot thank enough all the info in this post

A AlexaB
Black&White

 

[babiesmom5]

Hello Moises,

I am very sorry about your cat Penny being diagnosed with Bowenoid in situ carcinoma. The good news is that it is very treatable, very manageable. I do hope you read my lengthy previous thread about my cat's experiences with this disease, as well as the experiences of others with cats having this disease on that thread. This may help answer some of your questions.

My cat who had Bowen's disease passed away in 2022...but from something unrelated to Bowen's disease.
She was successfully treated for Bowen's for several years; at first with Imiquimod, but the lesions kept returning, so later we started cryotherapy with more lasting success.

I would strongly recommend your cat see a good vet Dermatologist. They are best able to diagnose and treat this very rare disease. My cat had cryotherapy treatments every few months as new lesions arose. She tolerated them very well with a topical local anesthesia after they shaved the surrounding hair. Each lesion is treated with one cryotheraphy session; one zap. So 5 lesions=5 zaps. Ten lesions=10 zaps. The cryotheraphy treatment usually eliminated the lesion, but occasionally a wider lesion, or deeper lesion required another zap or two, a month or two apart. The Dermatologist determined the need.

I would be a bit concerned about the lesions on Penny's leg and forehead that have been there three or four months. While Bowen's grows slowly, the longer the lesions grow untreated makes them more difficult to remove. A Dermatologist can determine the depth of these lesions, whether there is any cause for concern for going sub-dermal, which you definitely want to avoid.

My cat was elderly when she developed Bowens so we relied on less invasive treatments. For a younger cat, or one with extensive lesions, I understand that laser is a more effective, long lasting treatment. Of course it is more invasive and expensive. You can see photos, read about someone who used laser on their cat on my previous thread.

My cat did not experience nasal discharge, sneezing attacks from Imiquimod. It may be a reaction to that, I don't know; a Dermatologist would have to determine. I can tell you that the initial lesion on her head went undiagnosed for over a year because regular vet, even Internal Medicine vet could not determine what it was as this disease is very rare. Internal Medicine Vet did refer to Dermatologist who made the diagnosis via biopsy.

It is good you are talking with a vet, (although 300 miles away), but I definately feel you are on the right track if you want to get a handle on this disease. I wish you and Penny all the best of luck and if I can be of further help, answer other questions, do not be afraid to ask.

 

[FeebysOwner]

I do hope you read my lengthy previous thread about my cat's experiences with this disease

I looked for this thread to help the OP as they are new and may not be familiar with how to search for information. However, I did not come up with anything specific to Bowen's. Do you know what thread it was, and could you post a link here for the OP?

 

[fionasmom]

Bowen's Disease

I am not sure if this is the correct location, but CO2 laser is discussed around #20 in this thread.

 

[mani]

Yes, Moises originally posted in that thread. The thread was not B babiesmom5 's but that of a member who has not been back in some time, so we moved the thread here. So Moises is aware of the other thread.

Best to keep the discussion in this thread now.

 

[babiesmom5]

Bowen's Disease

I am not sure if this is the correct location, but CO2 laser is discussed around #20 in this thread.

Thank you so much fionasmom and mani for finding this original thread in which I posted in response to Black and White whose cat had Bowen's disease. I recalled it was several years ago and then the thread seems to have lapsed, and then my cat passed away in 2022, (not from Bowen's) so have not been back until now. I am happy to provide any help I can now to someone whose cat suffers from this rare disease.

 

[babiesmom5]

I looked for this thread to help the OP as they are new and may not be familiar with how to search for information. However, I did not come up with anything specific to Bowen's. Do you know what thread it was, and could you post a link here for the OP?

Thank you FeebysOwner for calling this to my attention. Thankfully fionasmom and mani found the thread in which I posted years ago before I did, or I would still be looking.

 

[Moises]

B babiesmom5 So sorry to hear your cat passed away in 2022, You should be happy you stretched his life all you can.

Thank you for the anwser and for the help from everbody to put this thread up.
I read the old one completely and now I got a much better idea about this Bowen's disease.

As you said B babiesmom5 I tried too see a dermatologist but they are not willing to see Penny, they always anwser its a case for a oncologist. My vet also want to give me a referral for a oncologist. Its a very weird situation, because I know the Bowens is rare and vet doesn't know about it but If I can found studies and this forum online, I am sure they could do it.

Yesterday, talking with the vet far away. I sent them all the info and photo from lesion and he recommended cryotherapy and 2 or 3 sesion will be needed. So we are moving think ahead although slow....
Thanks everybody for try to find useful info and help. Its overwhelming who I feel our help more than some professional in my area....

 

[babiesmom5]

Thank you for your kind words of sympathy for my little girl, "Light" who passed away at the ripe old age of 21 1/2. She was diagnosed with Bowen's at age 19, but she had this lesion on her head for over a year before being finally diagnosed. Vets would try this cream, this and that remedy, but of course the lesion was unresponsive until her IM vet (for CKD) referred her to a Dermatologist within the same clinic.

Because Bowen's disease is so rare, vets rarely consider this as a possibility. Her regular vet, in practice for many years, said she had only seen one instance of Bowen's in her entire career. It is something all but the most experienced vets often miss, and or mis-diagnose.

Perhaps the dermatologist you tried to see has not dealt with many cases of Bowens; hence they referred you to an Oncologist. In any event, at least you are finally getting some traction! I would definitely pursue this route, and the cryotherapy. I think the vet is right about 2-3 sessions will be needed since the lesions have gone on for so long, and have multiplied. Likely you will need to monitor closely at home and keep in close touch with the Oncologist for follow ups.

I must tell you in advance, after the cryotherapy treatments, don't expect the lesion to disappear. It may lessen in color, size and shape, (getting a bit red and irritated at first), but you won't necessarily see results with your own eye on the skin. Several times, I questioned the effectiveness after a cryotherapy session based on what my eye was seeing. Only when the Dermatologist looked with her eyes, her magnifying lens, could she definately tell me that "Yes, the lesion has abated". "Everything is ok".

I'm glad you were able to read through the old thread and glean useful information. Perhaps you could relay some of this to your Oncologist when you see them. You are a very good cat parent going the extra mile, literally, to get help for Penny. Please keep us updated on your progress as you can. All of us here have been down this difficult road with our babies, and we are walking with you.

 

[Moises]

Thanks B babiesmom5 for the extended details about treatment.
At the moment, and maybe its a wrong decision but I refused the Oncologist referral, its very expensive, its far away, they have no Laser and not cryotherapy, also they recognised they don't know too much about Bowen's. I think we know the treatments options and the oncologist cannot offer any of them so I see pointless go to them and spend time and money to tell me what I already know. I may do a blood test to see how is the liver but I can do that in my vet. Or you thin I am wrong? You think Penny can benefit from the oncologist and they can offer another treatment. Some vets, which I contacted to see if they have laser or cryotherapy, offer me immunotherapy, electrotherapy... I am not sure if they are confuse with the illness because they never see this illness and it has the word "carcinoma" or actually these therapies will help to the Bowen's.

Bowens in Penny was diagnosed with biopsy from 4 excisions the second week the lesion come up in her skin. After that, we controlled all of them with the imiqimod cream, some of them went away only with 2 application of the cream. So we got comfortable with no shaving her enough and maybe not applying the cream properly. Our mistake...
We always leave the cream in the cat until the body absorbed it, I read you or someone else in the previous thread wipe out the Imiqimod after one hour. That is why maybe she has been with the nasal discharge and sneezing, for some kind of poison with the cream. Now we are doing things better and I can see how the lesion in the head is getting smaller and flaking out, and the lesion in the leg is loose, only attached to the leg for a corner, I don't want to pull it out and still applying Imiqimod every other day but I think (hopefully) that lumpy lesion in the leg will drop.

Thank you!!

 

[babiesmom5]

I was under the impression from your prior post that this Oncologist had Cryotherapy and recommended 2-3 sessions? Maybe I misunderstood. I do understand from your standpoint, given the distance and cost, that you prefer to remain local and continue to use the Imiquimod.

It was my experience that Imiquimod, while initially helpful, has diminished effectiveness given the penchant of Bowen's disease lesions to spread in number and area. This is why we went to the next step; Cryotherapy.

With Imiquimod, you have to be very careful that the cat does not lick where it has been applied. What I would do is apply the cream to the bare skin, then sit with the cat on my lap for an hour or so while the medication absorbed. Then I would take a tissue and gently wipe residue off. This was the recommendation of my vet. Prior to this, I would apply it at night, wipe it off next morning, but the cat would lick and it upset her stomach. Imiquimod affects each cat differently; with my cat, she got nauseous. With your cat she possibly got nasal discharge, sneezing as side effects.

I do think while using Imiquimod, you might want to be thinking of a Plan B for the eventual likelihood that the Imiquimod cannot contain the lesions or diminishes in effectiveness. Is there a Veterinary teaching school not too far away from you? They generally have comprehensive specialty clinics, likely a Vet Dermatologist. I would be asking around, inquiring with other vets for recommendations, possible referrals in the future. I wish you and Penny the best of success whichever route you go. As always, we are here to answer questions, provide support.

 

[Moises]

Sorry that was a misunderstanding.
The vet far away is just a "normal" vet specialist in dermatology, not an oncologist, which is open to see and treat Penny without referral.
I am open to cryotherapy or laser, open to everything really... but I cannot find any oncologist with equipment to do laser or cryo, that is why I declined the oncologist referral at the moment. Because I don't know any oncologist in this country who have the equipment for these therapies.

Today I asked my vet about a referral for dermatology, and she anwser the Bowen's is the previous of a malignant cancer, so its a field for an oncologist, nothing to do with dermatology. She also told me the cryotherapy has never been done in pets so that is why vet have no cryotherapy treatment. I don't know how a vet can be soo wrong... We really feel alone without help from our vet.

Anyway I found today online another 3 clinic with cryosurgery equipment closer to my city and they are open to help if they can, so things is moving forward if the imiqimod is not effective anymore.
B babiesmom5 What sequence of days did you use imiqimod and see more effect? Every other day, 5 on 2 off, 2 on 1 off?

 

[fionasmom]

Today I asked my vet about a referral for dermatology, and she anwser the Bowen's is the previous of a malignant cancer, so its a field for an oncologist, nothing to do with dermatology

I had wondered if this was the way that the doctors were looking at Bowen's. Not that it helps you much. I hope that the closer clinics might be able to be of some assistance.

 

[babiesmom5]

Ok, thanks for explaining about your vet "far away". I understand now.
Like Penny, my cat was diagnosed with "Bowenoid in situ carcinoma". It is a multi-centric squamous cell carcinoma and occurs in several areas of the body, but it is not technically a metastatic cancer. The term "in situ" means "in the original place" meaning that the lesion has not moved from its original place; the skin.
How a form of skin cancer is treated may vary by country. Here, skin cancer is treated by a Dermatologist unless it metastasizes, spreads to organs.

Humans can get Bowen's disease also. In fact, a cat friend (who I met here on TCS), has a mother who had Bowen's disease lesions on her leg. She lives in the south of England. She had used Imiquimod for a time, but the lesion grew, so it was surgically removed in a hospital. I think she had radiation therapy afterwards. I believe her treatment was directed by an Oncologist.

It is encouraging that you found three clinics closer by which use cryotherapy. Basically this is a CryoPen. It looks just like a pen and comes in different sizes depending upon the scope of the lesion.

As for the Imiquimod, my cat was initially prescribed application every other day, but she couldn't take it that often as it made her nauseous, reduced her appetite; not good as she had CKD also. So the dermatologist reduced the application frequency to twice a week which worked better.

I do hope you will be able to find a good vet responsive to your cats needs close by. Please keep us updated on your progress.

 

[silent meowlook]

Hello.
I don’t know if you read this study yet. It might be helpful. In all honesty, I could not read the entire paper right now.

https://www.researchgate.net/public...e_of_identifying_mild_and_superficial_lesions

If her medication is causing elevated liver enzymes, ask your vet about using a veterinary liver supplement, Denmarin.

Veterinarians usually are members of VIN. The veterinary information network. On that site they can find specialists near you and obtain information and guidance from other veterinarians and veterinary specialists.
Veterinary Information Network^®, Inc.

This is a link to another site for veterinarians
WSAVA | World Small Animal Veterinary Association

 

[Moises]

Hello.
I don’t know if you read this study yet. It might be helpful. In all honesty, I could not read the entire paper right now.

https://www.researchgate.net/public...e_of_identifying_mild_and_superficial_lesions

If her medication is causing elevated liver enzymes, ask your vet about using a veterinary liver supplement, Denmarin.

Veterinarians usually are members of VIN. The veterinary information network. On that site they can find specialists near you and obtain information and guidance from other veterinarians and veterinary specialists.
Veterinary Information Network^®, Inc.

This is a link to another site for veterinarians
WSAVA | World Small Animal Veterinary Association

Thank you. I will speak to my vet to see if she knows anything about that.


I would like to update that we found another lesion in the back of penny we shaved and took photos, already applying Imiqimod. Its very tiny, so not a concern from previous experience.
We know the little black 1mm spot is the Bowen's, but what about the brown patches in the skin in the lower side of the shaved area and around the black spot?

I am not sure how the skin should be in my cat, When I show to my vet new lesions she said I don't know. put imiqimod in what you think it is Bowen's, but I am not sure the best option is cover Penny with imiqimod just in case... I remember to see always penny with the brown patches in the skin when we shaved previously or its my brain starting to play games...

what do you all think? Any photos about Bowens lesion in the back which I can compare?

 

[silent meowlook]

I am sorry your vet is far less than helpful. Obviously, she doesn’t have the knowledge or equipment to help you.
I also agree you need a dermatologist. Must you have a direct referral from your vet to see one or can you make the appointment yourself. If the latter, you need to speak with your vet.

Remember, you pay a veterinarian for a service they provide. You don’t owe them anything. Always be polite of course, but firmly advise your veterinarian that you are requesting a referral to a dermatologist. That’s it. Or even find your own veterinary dermatologist and advise the current vet to refer your cat there.

Below is a site for locating veterinary dermatologist in the UK. I am in the US and unfamiliar with how things work where you are.Here, some specialists require direct referral and some don’t.

There is so little information on this. It is sad that there isn’t more known about it. From what I have read, it maybe linked to the Bovine papalomavirus which I have seen on horses before. It shows on the insides of their ears as little white plaques. It is not treated, as far as I’ve seen) in horses. But Bowens is different yet they have found the papilloma iris in some of the histopathology samples.

I just wish there was more information out there.

 

[Moises]

I am sorry your vet is far less than helpful. Obviously, she doesn’t have the knowledge or equipment to help you.
I also agree you need a dermatologist. Must you have a direct referral from your vet to see one or can you make the appointment yourself. If the latter, you need to speak with your vet.

Remember, you pay a veterinarian for a service they provide. You don’t owe them anything. Always be polite of course, but firmly advise your veterinarian that you are requesting a referral to a dermatologist. That’s it. Or even find your own veterinary dermatologist and advise the current vet to refer your cat there.

Below is a site for locating veterinary dermatologist in the UK. I am in the US and unfamiliar with how things work where you are.Here, some specialists require direct referral and some don’t.

There is so little information on this. It is sad that there isn’t more known about it. From what I have read, it maybe linked to the Bovine papalomavirus which I have seen on horses before. It shows on the insides of their ears as little white plaques. It is not treated, as far as I’ve seen) in horses. But Bowens is different yet they have found the papilloma iris in some of the histopathology samples.

I just wish there was more information out there.

""The results from the masses that we removed have come back consistent with viral plaques, called more specifically "Bowenoid in-situ carcinomas". They are quite rare, and are thought to be pre-neoplastic, which means that they would have had the potential to develop into a malignant cancer if left.""

That is what I was told from my vet from the first surgery.

Could you post again the site for the dermatologist in Uk? I cannot find your link. Thanks


I hope I found a way out to find a solution and keep Penny as healthy as its in my hands.

Penny has nasal discharge from one nostril, I took her to the vet and in that time she has no discharge so Vet didn't do any checks, she just wrote in the medical history the cat doesn't like to open the mouth".

Today I read that nasal discharge can be a symptom for already squamous cell carcinoma. I hope it is not and its a side effects from licking the imiqimod cream. I cannot see anything strange in his nose, cheek or mouth...

I tried to be polite to the vet but I am loosing my patience with not help

 

[silent meowlook]

Referral guide

24 Veterinary Surgeons found who are Specialists in Dermatology

 

[babiesmom5]

I can well relate to your anxieties whether a spot is Bowen's or not. There were times when I thought a new spot was Bowen's but the vet (upon close examination) said it was not. Conversely, there were times when the vet (during a close examination) said a new lesion was Bowen's. It has been my experience that only a vet experienced in this disease can tell the difference.

I wouldn't panic when seeing a new spot, but I would try to find a good vet dermatologist soon. Hopefully the links provided on this thread may be of help.

As for the nose discharge, try not to think it as already squamous cell carcinoma. Remember, Bowen's is a V-E-R-Y slow growing disease. As long as you are keeping it "in situ" with treatment, there is no worry for it going sub dermal to a worse stage.

My Dermatologist told me from the outset that Bowen's is associated with the Papillomavirus. She said that most cases she sees are caused by that particular virus.