How Bowen's Disease Is Diagnosed

Bowen's disease is a skin disorder that presents as red or brownish patches of scaly skin that may occasionally itch. It is an early form of skin cancer, but since the cancerous cells grow only on the outermost layer of the skin, it is considered a minor condition that is treatable.

However, the patches of skin associated with Bowen's disease are easily mistaken for other skin conditions like psoriasis and eczema, so it's important to get a diagnosis from a doctor.

Skin exam
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Early intervention is critical in preventing the condition from progressing into a more invasive form of skin cancer called squamous cell skin cancer.

Diagnosing Bowen's disease involves taking a complete medical history, physically examining patches of the affected skin, and, in some cases, taking a biopsy of the affected area.

Self-Checks and At-Home Testing

There are no at-home tests that can diagnose Bowen's disease and no self-checks that can confirm a diagnosis of the disease. However, regularly checking your skin for abnormal growths or rashes and having a good understanding of the signs and symptoms of Bowen's disease will assist in knowing when to see a doctor.

In the majority of cases, Bowen's disease presents as patches of reddish to brown skin that may be scaly and dry.

The patches can be:

  • Slow-growing
  • Red, pink, or brown
  • Flat
  • Slightly raised
  • Scaly
  • Dry
  • Clear-edged

In most cases, the patches are the only symptom of Bowen's disease, but in some people, the patches may also be accompanied by other symptoms.

These include:

  • Itchiness around the affected skin patch
  • Tenderness of the affected skin patch
  • Patches that have warts
  • Patches that split open
  • Patches that have a dark pigment

The patches most often occur in areas of the skin that see the most sun. These include:

  • Scalp
  • Face
  • Neck
  • Hands
  • Lower legs

Less commonly, the patches may appear in areas that don't often see the sun. These areas include:

  • Palms
  • Soles
  • Groin area
  • Genitals
  • Penis

In most people, there is only one patch of affected skin, but in roughly 10% to 20% of people with Bowen's disease, there may be multiple patches found across more than one area of the body.

In some people, Bowen's disease can progress to more invasive forms of skin cancer. This is often accompanied by an additional set of symptoms.

These include:

  • A lump on the affected area of skin
  • An ulcer on the affected area of skin
  • A nodule that may bleed in the affected area
  • A nodule that may be tender in the affected area
  • Hardening of the affected area of skin

Physical Examination

Bowen's disease cannot be self-diagnosed. A doctor needs to make an official diagnosis.

To reach a diagnosis of Bowen's disease, your doctor will take a full medical history and do a thorough physical examination of the skin. In some people, Bowen's disease may first be found in a routine dermatology examination or skin cancer screening.

Bowen's disease can sometimes be mistaken for other conditions of the skin like psoriasis or eczema. For this reason, the doctor will look carefully at the affected patches of skin to try to find signs of Bowen's disease if the condition is suspected. A doctor will often be able to make a diagnosis based on the appearance of the patches of skin to the naked eye. No other scans or imaging are usually needed.

In some cases, your primary care doctor will refer you to a dermatologist.

Labs and Tests

Bowen's disease appears as patches of red or brown scaly skin, but so do other conditions like eczema and psoriasis.

For this reason, if your doctor isn't confident in the diagnosis from a physical examination of the skin patches, they may also do a biopsy to confirm.

Biopsy

During a skin biopsy, a sample of affected tissue is collected to later be examined under a microscope.

There are three methods of performing a skin biopsy:

  • A shave biopsy, which removes a sample of affected skin by using the blade of a razor
  • A punch biopsy, which collects a sample using a circular tool
  • An excisional biopsy, which collects a sample using a scalpel, a type of small knife

A skin biopsy may be performed in your doctor's exam room or at an outpatient facility.

A biopsy will help doctors exclude other skin disorders and confirm a diagnosis of Bowen's disease. The sample taken during the biopsy is typically deep enough to also rule out other forms of skin cancer, like squamous cell carcinoma.

Differential Diagnoses

The symptoms of Bowen's disease can sometimes be mistaken for other skin disorders. This is because red patches of scaly skin can be found in a number of conditions, including psoriasis and eczema. In diagnosing Bowen's disease, a doctor may also want to rule out these other conditions:

Psoriasis

Psoriasis is a skin disorder that appears as patches of red, thick skin that is itchy or sore. The patches may have a silvery hint to the scales. Psoriasis can appear on any part of the body but is most commonly found on the knees, face, elbows, scalp, back, palms, and feet.

Like Bowen's disease, psoriasis can be hard to diagnose because many conditions cause similar patches of red scaly skin. A biopsy can differentiate psoriasis from Bowen's disease as well as other skin disorders.

Eczema

Eczema is an umbrella term for a number of skin conditions that cause itchy dry skin accompanied by a rash. Most forms cause the skin to be itchy and dry and can cause a rash on the hands and feet, behind the knees, on the face, and inside the elbows.

Scratching from eczema can cause the skin to become red and swollen, worsening symptoms. A biopsy will be able to distinguish Bowen's disease from eczema.

A Word From Verywell

Bowen's disease can be tricky to diagnose because the symptoms mimic other skin conditions, so it's important to consult your doctor about any red or brown scaly patches of skin that persist. If Bowen's disease is suspected, your doctor will make a diagnosis based on a physical examination of the affected skin. In some cases, they may take a biopsy to confirm the diagnosis before recommending a treatment plan.

Bowen's disease is usually easily treated, and can be completely cured in many cases, so getting an accurate diagnosis is the first step toward getting back to a healthy, vibrant life.

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7 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. Oxford University Hospitals. Bowen's disease. Updated July 2020.

  5. Medline Plus. Skin Biopsy. Updated December 3, 2020.

  6. Medline Plus. Psoriasis. Updated February 20, 2019.

  7. Medline Plus. Eczema. Updated August 15 2016.