Signs and Symptoms of Bowen's Disease

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Bowen's disease, also called squamous cell carcinoma in situ, is an early form of skin cancer. In Bowen's disease, cancerous cells grow in the outer layer of the skin. It is considered a minor condition and can be treated effectively. In a small number of cases, it can progress to more invasive forms of skin cancer.

Bowen's disease often presents as a red patch of skin that may be scaly. Some people may have more than one patch. Patches typically grow slowly and may be the only symptom of Bowen's disease.

Nurse checking older woman's skin

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The disease only impacts the very outer layer of the skin, and the patches are not typically painful. Many people with Bowen's disease have no other symptoms.

In this article, you'll learn more about the symptoms of Bowen's disease, possible complications, and when to see a doctor.

Frequent Symptoms

The most common symptoms of Bowen's disease are patches of reddish-brown skin that may be scaly or dry. The slow-growing patches may:

  • Be flat or raised
  • Itch occasionally
  • Be red or pink
  • Ooze pus (if the patch of skin is infected)
  • Bleed
  • Be a few millimeters to a few centimeters in size
  • Crust
  • Feel Tender
  • Have clear edges
  • Not heal

Most commonly, the patches appear in areas of the skin that see the most sun exposure. Patches most frequently are found on:

  • The hands
  • The scalp
  • The face
  • The neck
  • The lower legs

Generally, Bowen's disease doesn't cause symptoms other than patches of red, scaly skin. But some people may notice an occasional itch. Others may also notice raised or rough patches that catch on clothing.

Rare Symptoms

There are some rare symptoms associated with Bowen's disease that only occur in some people.

In most cases, only one patch of skin will be affected. But in about 10%–20% of people with Bowen's disease, multiple patches or lesions may develop, usually on more than one part of the body.

Other rare symptoms include:

  • Dark-colored patches of affected skin
  • Patches or lesions that split open
  • Patches of affected skin that have warts

Less commonly, the patches of skin may occur in areas of the body that are not often exposed to the sun. These include:

  • Anal areas
  • Groin areas
  • Palms of the hands
  • Soles of the feet
  • Genitals

Complications

Those living with Bowen's disease have an increased risk of developing skin cancer. This is believed to occur in less than 10% of people with Bowen's disease. The risk can be higher for those who have Bowen's disease and also have a compromised immune system.

Symptoms that might be an early sign of Bowen's disease transforming to cancer are:

  • Bumps in patches of affected skin
  • Fleshy nodules in areas of affected skin
  • Nodules in the affected area that are tender
  • Nodules in the affected area that bleed
  • Ulceration of the affected patch of skin
  • Hardening of the affected patch of skin
  • Bleeding in the affected patch of skin

About 3.5%–5% of people with untreated Bowen's disease will develop a type of skin cancer called squamous cell carcinoma.

This is the second most common form of skin cancer. If detected early, it can be treated effectively. However, if left untreated, the lesions associated with squamous cell skin cancer can cause disfigurement, and eventually cause death as cancer grows deeper into additional layers of the skin or spreads throughout the body. Each year, an average of 15,000 Americans die from squamous cell carcinoma.

When to See a Doctor

Bowen's disease can sometimes be mistaken for other conditions like psoriasis or eczema. For this reason, it is important to see a doctor to get a diagnosis of Bowen's disease.

If you have patches of brownish-red and scaly skin that do not go away, you should see your doctor. The doctor will examine your skin, take a medical history, and in some cases, may take a sample of skin (called a biopsy) from the affected area to confirm a diagnosis of Bowen's disease.

Your doctor may also refer you to a dermatologist for further management.

For those with confirmed Bowen's disease, there are treatment options available including surgery, photodynamic therapy, cryotherapy, creams, and scraping the affected skin away after you're given a local anesthetic. In most cases, treatment is highly successful and in some cases, the disease can even be cured entirely.

If you have had treatment for Bowen's disease, you should make an appointment to see your doctor if you develop any of the following after treatment:

  • The patch of affected skin develops a lump.
  • The patch of affected skin changes in appearance.
  • The patch of affected skin starts to bleed.
  • New patches of affected skin have appeared.

A Word From Verywell

Bowen's disease is an early form of skin cancer that is considered minor and easily treatable. The disease presents as patches of brown or red scaly skin that may itch occasionally. In some people, the patches are the only symptom of Bowen's disease they will experience. In other people, some rare symptoms may also occur like dark pigmentation in patches of the affected skin, patches that split open, or patches that have warts. In some cases, Bowen's disease can lead to complications like more invasive forms of skin cancer.

Early detection goes a long way towards stopping the progression of the disease and avoiding additional symptoms or complications. This is why it is important to see a doctor for an accurate diagnosis and to begin treatment as soon as possible. Treatment of Bowen's disease can be highly successful and in some cases can be cured entirely. If you have any concerns about your skin or symptoms you may be experiencing, schedule an appointment to speak with your doctor.

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6 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. Updated November 9, 2020.

  3. NHS. 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.

  6. Skin Cancer Foundation. Squamous Cell Carcinoma Overview Updated May 2019.