Bowen's Disease

[babiesmom5]

I am so glad your dermatologist wants to pursue the Co2 laser treatment 'ablation". From what I read, this is the most effective treatment; far superior to the Imiquimod or even Cryotheraphy. To perform this procedure, the cat must be fully anesthesized. With a younger cat such as yours, this should not pose a problem. If I were you,( with your vets approval), I would definately go for it. My only hesitation is my cat is 19 1/2 years old with CKD, so try to minimize needs for anesthesia. Yes, it is more expensive, but I think results are far more long lasting and effective. Also, this treatment method removes the lesions on the skin, thus preventing it from going deeper and becoming (more lethal) Squamous Cell Carcinoma. Here is a very good article describing this treatment along with good pictures.

Bowenoid in situ carcinoma in cats: CO2 laser treatment

I do hope your cat can be evaluated by a cardiologist, which will be helpful prior to any anesthesia.

After my experience with Imiquimod and Cryotheraphy, I think Co2 laser is the only way to go in attacking this very persistent Bowen's Disease. Be very thankful your cats kidneys allow for this option. I am happy for you and look forward to following you and your cat's progress with high hopes!

 

[Black&White]

Thank you for that reply and encouragement, we have a few updates and I would be interested in your thoughts about this. My feeling is that we should simply get the ultrasound done and aim to have the ablation. But I will explain. The derm in Vancouver who does the ablation has suggested we see an oncologist first, also in Vancouver, to assess her condition and discuss a possible alternative treatment plan. The reason is that the derm would need to do an initial consult then book the ablation on another day which means two trips to Vancouver. So they suggested seeing an oncologist first, who may have another idea.

There is also the issue of her level 1 heart murmur, we either would need to have an ultrasound done or have a veterinary anesthesiologist present during the ablation which adds to the cost. They are suggesting to see oncology first which may mean an anesthetic would not be required.

My Vet just emailed about the oncologist which I will post here:

The cost of the initial consult with Dr Charny would be $265.00 plus tax,
plus your travel time and expenses over to Vancouver. She would then examine
and go through what has been done and assess how she has responded,
from there she would present you a treatment plan, with costs and an idea of
what to expect from the treatment. The idea of going to an oncologist is
that she may have an option that does not require an anesthetic (which the
laser ablation does). I really do not know what the options will be and what
the costs would be. The Imiquimod, is the first line treatment that is
recommended.

My sense from our discussion here on the forum is that they will simply suggest having the ultrasound done and the ablation. Do you think there would be another alternative that is better?

In the last two weeks I have been shaving the spots with a shaving razor, which actually works quite well, and dabbing her chest scabs with water. Just yesterday I felt as though we have reached a turning point with the Imiquimod, the scabs on her chest are greatly reduced, and finally flaking off completely on one side. The ones on her head seem to be gone, and her cheeks have also greatly reduced and seem to be almost gone on one side. We skipped a day to give her a bit of a break and I noticed her mood and energy was very good yesterday. I hugged her and told her we are beating this and she really purred, I know she feels it too!

 

[Black&White]

Looking at the chest scabs during her application today, I have to say they are very stubborn, and after 3 months now, should I not expect they would be gone? While the ones on her head are almost gone, and one cheek is responding well, the other cheek has some very persistent scabs and i see some spreading. Some respond very well, in 2-3 sessions they virtually disappear, and others seem to be stuck...

 

[babiesmom5]

I apologize for my delay in responding. We were out of town yesterday taking my girl to her Cardiologist for follow up. She is fine; no changes from last time so we can put the heart issue on the back burner now.

My understanding of Bowen's disease is that it is a slow growing type of cancer on the skin. As long as it remains on the dermal layer (in situ) it is manageable dermatologically. My dermatologist never suggested an oncologist consult because it was in situ per the biopsy. Now, if it had penetrated beneath the dermal layers, then it becomes Squamous Cell Carcinoma and that is a another ballgame. I think at that point, I would have been referred to an Oncologist who is there at the same specialty clinic.

As far as options an oncologist could suggest from the standpoint of Bowen's disease in situ, I am not aware of any other treatment options other than Imiquimod, Cryotheraphy, surgery, or Co2 Ablation. As the article I previously referenced here states, the Co2 Laser ablation is the superior treatment in preventing advancement of the disease into Squamous Cell Carcinoma.

Your cat, like mine is dealing with multiple lesions. Some are more resistant than others. For mine, it was the head which has taken 4 passes of the Cryotheraphy pen, and this is after surgery, plus months of Imiquimod. It now appears under control, but will likely take additional treatments if/when it returns.

In your case it appears the chest scabs are the most resistant. If I understand correctly, you have not had the chest scabs biopsied? Do you see them improved significantly? Three months does seem like a long time not to have seen significant improvement...if they are still dermal (in situ). You might want to ask about possibly biopsy of this to ensure it is indeed still dermal. They can do this quickly with a local anesthetic. If this is the worst area, and if it is still dermal, then I would go for Co2 ablation of all of them.

So, I would start with the Dermatologist consult but also inquire about biopsy of the worst/unresponsive lesions. I think this will more clearly bring into focus your next step. I hope this helps some. There are no easy answers here, but I think some valuable insights will be gleaned by having a Dermatological evaluation of all the lesions and progress made thus far.

 

[Black&White]

Thank you so much! That was very helpful to read, and glad to hear your kitty is doing well

I talked to the derm office in Vancouver today and asked why they suggest to see an oncologist, and mentioned what you said about the limited treatment options. They maintained that there might be some 'new' treatment options that have been developed more recently, and that they still recommend it. But she said a remote consult with them was still an option - they would look at recent photos compared to those taken Oct 1st by my vet, go over her files, and perhaps recommend a new biopsy. I could then go over and have the ablation done in one day.

There is no indication from anyone at this point that it might have progressed below the skin, unless they suspect from the weight loss. But her weight has stabilized when we last checked. I would think before seeing an oncologist, they would need to do another biopsy to determine if it has advanced to Squamous Cell Carcinoma. The derm clinic seems to believe there may be other options beyond what they offer. I'm not sure about their reasoning, perhaps it would give one more perspective beyond there own?

A biopsy was taken in July, in three places, including one on her chest. They said they are in situ. Her chest lesions have improved, they were thick black scabs 3 weeks ago, and now they are quite thin and pinkish. The most significant changes have happened in the last three weeks since I started dabbing them with water, using a coarse cloth to rub them, and shave the area with a razor. That seems to have helped. One lesion is close to gone on her chest, but the other is more resistant.

Thank you again for your help, it is always a pleasure to read your replies!

 

[babiesmom5]

I am getting a "sense" here that the dermatologist wants to defer to the possible expertise/knowledge of the oncologist. It has been my experience that specialists (both doctors and vets) do not want to step on the toes of another specialist or prescribe outside their area of expertise, thus exposing themselves to possible liability. I think your dermatologist would feel more comfortable having the oncologist weigh in prior to his/her evaluation. So, I think it may be to your advantage to get the remote consult with the oncologist, see what they say re treatment progress, any new treatments available. It certainly couldn't hurt and might provide some new insights. For sure, it would give "cover" to the dermatologist.

It does sound from all indications that the lesions are all still "in situ" which is good news. While Bowen's is a very persistent disease, you have certainly been a very good and proactive mom...keep it up!

 

[Black&White]

Thank you again, you really have a very clear headed way of seeing things! That's what I'll do, thank you

 

[Black&White]

Hi Babiesmom5, it's been quite a while since I last posted, I hope all is well. Nothing serious has changed, I have just been very busy running a new business which has taken all of my time.

I wanted to attach 3 photos to ask for your thoughts about how they look to you. These have been the most resistant lesions, one is finally beginning to clear (Pic 2) with some of the lesion finally gone. When this all started these all were very large growths, even beside her mouth. Now they are flat to the skin, but still very resistant.

Pic "1" has been like that for quite a long time, I thought it would clear by Xmas, but it just remains more or less the same.

The one close to her mouth (Pic 3) begins forming a scab within the 2 days of treatment, I rub it off with a wet towel, and reapply. You can't really see anything from the Pic, it just forms a light scab over 2 days.

We ended up not going to the oncologist, and have not had the laser therapy. The vet said that based on how they look (same as pictures), we should continue to apply the Imiqimod. She occasionally has outbreaks in new places, and has some new ones on her head, but they generally clear up within 2-3 days of treatment.

I have considered applying everyday, or 2 days in a row - 1 day off, or 3 days in a row - 1 day off, etc, what do you think?

 

[babiesmom5]

Hi,
Thanks for the update on your kitty. I've been wondering how she was. Based on these three photos, none of them look too bad. All look like they are under control, although the one near the mouth is the most prominent. From my experience, none of the dark spots ever totally go away. They do subside, get smaller, but skin doesn't return to normal pink. Your kitty's lesions are as good as it gets under control.

My cat has the original outbreaks on head, neck and back kept in control through cryotheraphy about every 6-8 weeks. However, there are new smaller outbreaks near the original ones. These are too treated with cryotheraphy. She has developed a few small ones near the eye which I will ask about next time.

As for frequency of Imiquimod, my vet initially began that treatment with twice weekly applications, then if no reactions/irritations, it was increased to every other day. So if your cat can tolerate it at that frequency, you might try it, but monitor closely. I would give it a day or so rest in between.

As we both know, Bowen's is very resistant. It is caused by the Papilloma virus, which, once in the body, never goes away. It can only be controlled and the key is to keep the lesions dermal, not internal. So far, you have been doing a very good job!

Good luck to you in your new business! Post anytime with updates on your girl.

 

[Black&White]

Thank you for your feedback! I'm happy to hear that and will continue every other day as we have been doing.

 

[Black&White]

Kitty says thank you, too

 

[Black&White]

Hello Babiesmom5,
I'm just sitting here with my kitty plastered across my lap, and I wanted to share a couple of photos from today to see what you think of this lesion. In 'lesion 1' pic I am wondering if the circular part above the more scabby part on the bottom is still an active lesion? I would say yes, but I also attached 'lesion 2' pic which is after I scrub it off with a wet cloth. While it is a bit moist it seems to disappear, but just after 2 days the scab reforms as in the 'lesion 1' pic. What do you think?

 

[babiesmom5]

In my opinion, where there is scab, there is active Bowen's. A scab would not re-form where the lesion is completely eliminated. It is not a bad lesion, but in my opinion it is still active, so would continue to treat.

Bowen's is persistent. It appears you have it under control, much improved, but still there. That is the same with my girl who goes back to see the Dermatologist on Friday. I think we have things under control, but there is a lesion very close to her eye that makes it difficult to treat with the Cyrotheraphy pen.

You appear to be doing a very good job Mom...so keep at it!

 

[Black&White]

Thank you!

 

[Black&White]

Hello Babiesmom5,

Hoping you and your cat are well, we just finished 2 record breaking weeks of sunny weather here in Victoria, and now back to another week of rain ahead.

We had a few updates, and wanted to share them with you to see what you think. Kitty has a few new lesions, I have attached a couple of photos of each of the main ones, on her lip, and a new one on her left leg. This is the first time she has had one that is not on her head or neck, so I was a bit worried.

The new one on her upper lip is quite swollen, you may also be able to see two ting brown scabs below it and at the edge of her mouth. They are a bit hard to see in the pics, but I was wondering what else I could use to dab them? My finger is a bit large and inaccurate for those.

The one on her leg she licks at, I was going to ask the vet for a bandage, I remember they used one to cover where she had an injection.

We now have an Oncologist in Victoria near where we live: Oncology

I had contacted Dr Udenberg's office again last week, he is in Vancouver, to see about having the laser ablation done. They let me know about the new oncologist, and that we should have her checked there first. Dr Udenberg is actually on staff there, he comes over from Vancouver once per month, so we may try to see him there as well.

I know we discussed about the oncologist before, and how it would most likely not be of any help. We already know what the treatment options are, in fact we had Dr Udenberg write a report for Kitty at the end of last year, which our Vet read to us. Nothing we didn't already know, with our vet informing us that it would cost 'thousands' with multiple tests needed to have the ablation done. I think that may in fact have been their intention, to try and dissuade us from having it done, or at least to make it seem so complicated that we wouldn't bother with it, due to the cost.

We have been doing the Imiquimod treatment now for about 7 months, it's really just one large one on her neck that is not changing, with a couple of smaller ones that are also very resistant. The others seem to respond well to treatment and disappear after a few applications.

Anyways, I just wanted to see what you think, I have not found someone who could do cryotherapy, that would be preferable. I will call the Jubilee in Victoria on Monday, as well as Dr Udenberg's office in Vancouver to see what they suggest.

 

[Black&White]

I wonder if Babiesmom5 might be away? Just a short update then, Kitty's new sores are healing and we seem to be much better this week. We have an appointment booked with Dr Udenberg in Vancouver in July, and may try to see the oncologist in Victoria beforehand. Hoping all is well with Babiesmom5, if and when she may return...

 

[Black&White]

Kitty had surgery to remove a few lesions on her chest, the biggest one and 3 smaller ones. Also a small one near her ear. She is recovering well after a week, although we had quite a scare after the surgery when she was not recovering from the anesthetic and her temperature was stuck at 32ish.
There is just one very resistant one left that has not responded to the aldara cream for the last year, and the Vet said he could not remove it without serious difficulties.
I am attaching a photo and just wondering if there might be some further thoughts about it here.

 

[fionasmom]

Thank you for posting this update. I hope that your kitty continues to improve and that all side effects of the surgery are now over.

B babiesmom5

 

[babiesmom5]

I apologize for not seeing your posts as I've been a full time nurse for my 20 year old girl. She just returned from a lengthy stay in the ER due to pancreatitis, azotemia, anemia requiring a blood transfusion. While there a small mass was discovered in her intestines. She is at home recuperating and we treasure each day we have her as a gift.

She still has the Bowen's, and was actually treated several weeks ago with Cyrotherapy pen. This has effectively taken care of all her lesions, especially one very close to her eye. I think wherever possible, surgery is advisable in those locations where it can be done. My girl's original lesion on her head was removed surgically several years ago, but then it slowly returned; first treated with Imiquimod, then when she could no longer tolerate it, Cyrotherapy.

I really think on sensitive areas such as near her mouth, (as on her photo) where surgery and Aldera is not feasible, the best option is Cyrotherapy. They use a very fine tip point which clears it up. It may reappear later, in which case you can zap it again. Cyrotherapy is the only effective method I am aware of that treats lesions in very sensitive areas. I would try to seek out a Dermatologist vet who uses this technique.

I am glad to hear your kitty is recovering after her surgery and I hope she continues to do well.

 

[AlexaB]

Hi I am so glad I found this forum because my 16 years old cat has also been diagnosed with Bowen's about 6 weeks ago and I was very frightend and panicked but I read your discussion and I was a bit more optimistic so thank you for that . It took more then 1 year to have my cat diagnosed because the vets we saw, all treated her for skin infections. We finally got to a dermatologist who knew immediately what it was, he did a biopsy and it was confirmed it is Bowen's (in situ for now). We started the treatment with Aldara 5 weeks ago but I do not see much progress so I am a bit scared that it's not working. How soon after you started the treatment did you see the lesions become smaller? Do they just shrink or do they also change color? My cat has a big patch of black skin on her neck (basically her whole neck) - some areas are really black and some are dark grey let's say. That is the area I started with so here we have a full 5 weeks of treatment. I saw her skin flaking but I do not see the black area shrinking and the skin becoming pink or something so I am trying to understand if the treatment is working at all. It's pretty hard to be sure if it is or it is not working because she has a lot of lesions one near the other, in some areas they seem to melt together and form a big patch of black skin . On top of that she has some ulcerations with thick crusts. Those I saw shrinking so I am wondering if that is the first effect of the cream? I wanted to attach some pictures but they are pretty gross so I will spare you of that. Besides the ones on her neck, her back is full of smaller round black spots (some 1 CM in diameter, some smaller), some with crusts, some without. It seems that on her back, the black spots with no crust have become lighter in color but I am not even sure about thatbecause they all look so different and it's hard to keep track. Started making some pictures to be able to compare but I don't have the same lighting so...
I talked to the doctor about laser too but it's not done in my country so I will have to go to Austria for that. I am willing to do that although the cost will probably be huge but the doctor said he first wants to see the lesions stabilize before going for the laser so we will see what he will say after our next appointment.
Anyway, I wrote a lot but I am very worried and I am trying to understand what the effects of the cream are and when to expect to see real improvements (doctor said in about 6 weeks but we are almost there and I clearly do not see a big change)
I would be very greatfull if you could tell me how the lesions evolved for your cats