Bowen Disease
An early skin cancer confined to the top layer of skin
Quick Facts
- Type: Early (in situ) skin cancer
- Appearance: Persistent red, scaly patch
- Main cause: Long-term sun exposure
- Outlook: Very good with treatment
Overview
Bowen disease is a very early form of skin cancer, also called squamous cell carcinoma in situ. "In situ" means the abnormal cells are still confined to the outermost layer of the skin (the epidermis) and have not grown into the deeper tissue. Because it is contained, Bowen disease is highly treatable and rarely dangerous when caught early.
It usually appears as a slow-growing, persistent red, scaly patch that can be mistaken for eczema, psoriasis, or a fungal infection. If left untreated over a long period, a small proportion of cases can progress into invasive squamous cell carcinoma, which can grow deeper and, uncommonly, spread. For this reason, a patch that does not heal should be assessed, and Bowen disease is treated to prevent progression.
Symptoms
The typical sign is a stubborn patch of skin that does not clear up with ordinary creams.
- A red or pinkish, flat or slightly raised patch
- A scaly, crusty, or rough surface
- Slow growth over months to years
- Most often on sun-exposed areas such as the lower legs, head, neck, and hands
- Usually painless, though it may itch, crust, or occasionally bleed
Because it resembles common skin conditions, Bowen disease can be present for a long time before diagnosis. Warning signs that it may be becoming invasive include a lump developing within the patch, ulceration, bleeding, or sudden growth, all of which should be checked promptly.
Causes
The main driver of Bowen disease is long-term skin damage, especially from the sun. Contributing causes include:
- Ultraviolet (UV) light: Years of sun exposure, the most common cause.
- Human papillomavirus (HPV): Certain types can contribute, particularly in some genital and nail-area lesions.
- Previous radiation therapy to the skin.
- Exposure to arsenic, historically through some medicines or contaminated water.
- A weakened immune system, such as after an organ transplant.
Risk Factors
- Older age and years of accumulated sun exposure
- Fair skin that burns easily
- A history of frequent sunburns or outdoor work
- A weakened immune system, including from medications
- Prior radiation treatment or arsenic exposure
Diagnosis
Because Bowen disease looks like several common skin conditions, a tissue sample is usually needed to confirm it.
- Skin examination: A doctor or dermatologist assesses the patch and surrounding skin.
- Skin biopsy: Removing part or all of the patch for microscopic examination is the key diagnostic step.
- Full skin check: Looking for other sun-damaged areas or skin cancers, which can occur alongside it.
Confirming the diagnosis ensures the patch is treated appropriately rather than continuing with creams meant for eczema or psoriasis.
Treatment
Several effective treatments are available, and the choice depends on the size, number, and location of the patches and the person's overall health.
- Topical treatments: Prescription creams that destroy abnormal cells or stimulate the immune system, applied over several weeks.
- Cryotherapy: Freezing the patch with liquid nitrogen.
- Curettage and cautery: Scraping away the abnormal tissue and sealing the area.
- Photodynamic therapy: A light-activated treatment applied to the patch.
- Surgical removal: Cutting out the lesion, used for certain or thicker areas.
Treatment is highly effective, but follow-up is advised because new patches and other skin cancers can develop in sun-damaged skin.
Prevention
- Protect your skin from the sun with shade, clothing, and broad-spectrum sunscreen
- Avoid tanning beds and excessive sun exposure
- Check your skin regularly and note any patch that does not heal
- Have persistent red, scaly patches evaluated rather than self-treating long-term
- Attend follow-up visits if you have had Bowen disease or other skin cancers
When to See a Doctor
See a doctor or dermatologist if you have a red, scaly patch that does not heal, keeps returning, or does not respond to usual creams, especially on sun-exposed skin. Seek prompt assessment if a lump develops within the patch, or if it ulcerates, bleeds, or grows quickly, as these can signal progression to invasive skin cancer that needs timely treatment.
Frequently Asked Questions
Is Bowen disease cancer?
Yes, it is a very early form of skin cancer called squamous cell carcinoma in situ. The abnormal cells are confined to the top layer of skin and have not spread, which makes it highly treatable when caught early.
What does Bowen disease look like?
It usually appears as a slow-growing, persistent red or pink scaly patch, often on sun-exposed skin such as the lower legs, head, or hands. It can be mistaken for eczema, psoriasis, or a fungal infection.
Can Bowen disease turn into invasive cancer?
In a small proportion of untreated cases, it can progress to invasive squamous cell carcinoma over time. A lump forming within the patch, ulceration, bleeding, or rapid growth are warning signs and should be checked promptly.
How is Bowen disease treated?
Options include prescription creams, freezing (cryotherapy), scraping and cautery, photodynamic (light) therapy, and surgical removal. The choice depends on the size, number, and location of patches, and treatment is usually very effective.
How can I prevent it?
Protecting your skin from the sun with shade, clothing, and sunscreen, and avoiding tanning beds, reduces risk. Regular skin checks help catch persistent patches early, and follow-up is advised after treatment.
References
- American Academy of Dermatology Association. Squamous cell carcinoma in situ.
- DermNet. Bowen disease.
- National Cancer Institute (NCI). Skin cancer.
- MedlinePlus, U.S. National Library of Medicine. Skin cancer.