What Is Bowen’s Disease?

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Bowen’s disease (also called squamous cell carcinoma in situ) is a non-invasive early form of skin cancer, characterized by slow-growing patches of red, scaly skin. It affects the squamous cells in the outermost layer of the skin.

It is not considered a serious condition, but if left untreated, Bowen’s disease can develop into a more invasive form of skin cancer. Therefore, dermatologists often want to treat or at least monitor Bowen’s disease.

Learn more about the symptoms, causes, diagnosis, and prognosis for Bowen’s disease.

Symptoms of Bowen's Disease

Verywell / Theresa Chiechi

Symptoms

Bowen’s disease is characterized by patches of dry, scaly skin that can be flat or slightly raised. The patches are typically reddish-brown colored and can range from a few millimeters in size to a few centimeters. The patches may split open, have warts, or be dark colored.

The patches most commonly appear on areas of the body that get the most sun exposure, but can also occur in places that do not normally see the sun.

In most cases, there is only one patch. However, about 10% to 20% of people have more than one patch in multiple areas of the body.

The most common area for the patches to occur is the lower part of the leg. Less commonly, the patches appear on the soles of the feet, palms, genitals, neck, and head.

Typically, the patches of skin do not cause additional symptoms. However, in some people, the patches are accompanied by other symptoms, such as:

  • Itching
  • Oozing of pus (if the patch is infected)
  • Feeling tender to the touch
  • Bleeding
  • Crusting

Causes

Bowen’s disease is not infectious, and it does not run in families—that is, it is not hereditary. The disease typically affects older people who are in their 60s and 70s.

Risk Factors

The exact cause of Bowen’s disease is not known, but several risk factors for the condition have been identified, including:

Arsenic Exposure

Chronic exposure to arsenic might also be a contributing risk factor for Bowen’s disease. Research suggests that Bowen’s disease may appear roughly 10 years after initial exposure to arsenic.

Today, chronic exposure to arsenic is rare. In the past, people were more likely to be exposed to arsenic because it frequently contaminated well water and was used in medical preparations.

Diagnosis

Bowen’s disease is often diagnosed by examining the patches of skin. Sometimes, the disease is mistaken for other skin conditions that also produce patches of red, scaly skin, such as eczema or psoriasis.

A diagnosis of Bowen’s disease is usually made during a standard skin examination. A biopsy of the patch can also be taken to confirm the diagnosis and rule out other skin conditions.

Treatment

Bowen’s disease is curable, and there are several ways to treat it, including surgical removal, creams, freezing, or scraping. In some cases, treatment is not necessary and the condition is only monitored.

The appropriate treatment will be individualized and based on several factors, including:

  • Number of patches
  • Size of patches
  • Thickness of patches
  • State of the skin
  • Presence of any swelling

Freezing With Liquid Nitrogen

Freezing with liquid nitrogen can be done during a visit to a clinic, though it is usually done in stages for larger patches. After the treatment, the skin can be slow to heal and the procedure can cause blistering and crusting.

Excision

If the patch of skin is not too big, it can be cut out (excised). Before the procedure, a person is given a local anesthetic to make sure that they do not feel pain.

Curettage

Curettage involves scraping off the skin from the affected area. It is done under a local anesthetic. After the procedure, the affected patch of skin will heal like a regular scab or graze.

5-Fluorouracil Cream

5-Fluorouracil is a topical cream that kills abnormal skin cells. It can be used to either control or eradicate Bowen’s disease.

During treatment, the skin may initially look worse and red, but the skin will heal normally once the abnormal cells have been eradicated.

Photodynamic Therapy

During photodynamic therapy, a chemical is applied to the affected area of the skin. The chemical causes the cells in the skin to be sensitive to certain wavelengths of light. A special lamp is then focused on the affected area.

Photodynamic therapy may cause pain and inflammation, but it typically subsides after a few days.

Imiquimod Cream

Imiquimod was originally designed to treat genital warts, but it can also be used to treat Bowen’s disease. During treatment, it may cause some inflammation.

Radiotherapy

Radiotherapy and other forms of laser treatment are sometimes used to treat Bowen’s disease, but not in affected areas on the lower leg.

Observation

In some cases, the area of skin that is affected by Bowen’s disease is too thin for treatment. If the area is deemed unlikely to cause problems, the patches can be kept under observation rather than treated.

Prognosis

Bowen’s disease is typically not a serious condition. A number of effective treatments can control or completely cure it.

In some cases, undiagnosed or untreated Bowen’s disease can develop into a more invasive form of skin cancer called squamous cell skin cancer. Estimates suggest the progression occurs in one in 20 to one in 30 people with untreated Bowen’s disease.

People with Bowen’s disease are at risk for other forms of skin cancer, and they should be regularly monitored by a dermatologist.

Coping

People with Bowen’s disease need to take steps to protect their skin—for example, wearing a hat and sunscreen when outside (even on cloudy days) and wearing pants or long skirts to protect the legs from sun exposure.

Monitoring the skin and watching for any changes in the skin patches is another important part of managing the condition. If there is any bleeding, ulceration, or the appearance of lumps or growths, a person with Bowen’s disease should let their doctor know.

A Word From Verywell

Bowen’s disease is an early form of skin cancer that affects the outer layers of the skin. The condition is characterized by red, scaly patches of skin.

When it is managed, Bowen’s disease is not usually serious and can even be curable. However, if the condition is not diagnosed and goes untreated, it can progress to a more serious form of invasive skin cancer.

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5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. British Association of Dermatologists. Bowen’s disease (squamous cell carcinoma in situ). Updated January 2020.

  2. National Organization for Rare Disorders. Bowen disease.

  3. National Health Service. Bowen’s disease. Updated May 21, 2019.

  4. American Cancer Society. What are basal and squamous cell skin cancers? Updated July 26, 2019.

  5. Oxford University Hospitals. Bowen’s disease. Updated July 2020.