What is Bowen's Disease?

Written by Medicover Team and Medically Reviewed by Dr Koppisetti Satya Naga Ravi Teja , Dermatologist

Bowen's disease is a slow-growing form of skin cancer that affects only the outermost layer of the skin, known as the epidermis. Medically, it's referred to as squamous cell carcinoma in situ, which means the cancerous cells are present but have not yet spread deeper into the skin or other tissues.

This condition often shows up as a single persistent patch that may look harmless at first glance but continues to grow slowly over time. If left untreated, Bowen's disease can become invasive and spread into deeper layers of the skin, turning into full-blown squamous cell carcinoma, a more serious type of skin cancer.

What are the Symptoms of Bowen's Disease?

Bowen's disease can look different on each person. It often looks like other skin problems, such as eczema or psoriasis. But there are some clear signs to watch for:

A red, brown, or pink patch that is scaly or crusted
A lesion that is flat or slightly raised with a well-defined edge
Persistent dryness or rough texture that doesn't improve with moisturisers
Itching, mild burning, or tenderness
Gradual enlargement over months or years
Occasionally, the lesion may bleed or develop a sore that doesn't heal

These patches appear on areas exposed to the sun, such as the face, hands, legs, neck, and scalp. However, Bowen's disease can also develop in areas not exposed to sunlight, including the genitals, nails, or mucosal surfaces.

Because it mimics other common skin conditions, it's important to have any persistent skin change evaluated by a dermatologist.

What are the Causes and Risk Factors of Bowen's Disease

While the exact cause isn't always clear, certain environmental, lifestyle, and medical factors can increase your risk. Understanding these causes and risk factors is important for early detection and prevention.

Chronic sun exposure: Prolonged ultraviolet (UV) radiation from sunlight is a leading cause.
Exposure to arsenic: Industrial exposure or contaminated water in early life can increase risk.
Human papillomavirus (HPV): Certain strains of HPV, especially HPV-16, are linked to Bowen's disease in the genital area.
Weakened immune system: Immunocompromised individuals, like organ transplant recipients or those with HIV/AIDS, are more vulnerable.
Age and skin type: It most commonly affects people over 60, especially those with fair skin.
Previous radiation therapy: Skin previously exposed to therapeutic radiation may develop changes over time.

Understanding and reducing these risk factors can help prevent the onset of Bowen's disease.

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What are the Stages of Bowen's Disease?

Although not officially staged like other cancers, Bowen's disease can be understood in 3 clinical phases based on progression and skin involvement:

Stage 0 In Situ Stage (Pre-Invasive)

Description: This is true Bowen's disease. Cancerous cells are confined to the epidermis and haven't spread to deeper tissues.
Appearance: Red, scaly patch; flat or slightly raised with a clear border.
Risk: This stage is not life-threatening, but if left untreated, it may progress.
Treatment goal: Complete removal or destruction of the abnormal skin cells before they become invasive.

Stage 1 Microinvasive Transition (Rare)

Description: In some rare cases, the disease begins to penetrate the basement membrane (the boundary between epidermis and dermis), showing early signs of becoming invasive squamous cell carcinoma.
Appearance: Lesion may become thicker, ulcerated, or more irregular.
Risk: Higher risk of spreading to surrounding tissues if not promptly treated.
Note: At this point, the diagnosis may be upgraded to early invasive squamous cell carcinoma, not Bowen's disease per se.

Stage 2 Invasive Squamous Cell Carcinoma

Description: The abnormal cells have now invaded the deeper dermis and possibly the subcutaneous tissue. Bowen's disease has officially transformed into invasive squamous cell carcinoma (SCC).
Appearance: The lesion may bleed, crust, become painful, and grow rapidly.
Risk: The Risk of spreading to nearby lymph nodes or distant organs increases.
Treatment: Requires more aggressive treatment often surgical excision with margin, and possibly lymph node evaluation or further oncology referral.

Summary Table:

Stage	Name	Depth of Involvement	Risk Level
Stage 0	Bowen's Disease (in situ)	Epidermis only	Low (precancerous)
Stage 1	Early Invasion (rare transition)	Penetrates basement membrane	Moderate (pre-invasive)
Stage 2	Invasive SCC	Into the dermis or beyond	High (true cancer)

How is Bowen's Disease Diagnosed?

Since Bowen's disease can resemble other skin conditions, proper diagnosis is essential for accurate treatment. The diagnostic process typically includes:

Clinical Examination: A dermatologist examines the lesion's size, color, texture, and location.
Dermatoscopy: A handheld tool may be used to examine the skin more closely for early signs of malignancy.
Skin Biopsy: This is the gold standard for diagnosis. A small sample of the affected skin is taken and examined under a microscope to confirm the presence of cancerous cells confined to the epidermis.

In some cases, extra tests may be done to make sure it's not another condition. If the patch is on the genitals, doctors may also check for HPV.

What are the Treatment Options for Bowen's Disease?

The main goal of treatment is to get rid of the bad skin cells before they spread. The type of treatment depends on the size and place of the patch, your age, and your health. Common treatments include:

Photodynamic Therapy (PDT): A light-sensitive cream is applied to the skin, followed by exposure to a particular wavelength of light to destroy cancer cells. Useful for cosmetic areas like the face and scalp.
Curettage and Cautery: The lesion is scraped away (curettage), and the area is sealed with an electric current (cautery). This method is commonly used in outpatient settings.
Surgical Excision: The lesion is cut out entirely under local anesthesia. This offers a high cure rate and is ideal for larger or resistant patches.
Topical Medications: Imiquimod cream boosts the immune response to destroy abnormal cells. 5-Fluorouracil (5-FU) is a chemotherapy cream that targets rapidly dividing cancer cells. These are good options for patients who want non-invasive treatment or have multiple lesions.
Cryotherapy: The lesion is frozen with liquid nitrogen, destroying the abnormal cells. Best for small, superficial patches.

Your dermatologist will decide the most suitable method based on clinical evaluation. In most cases, treatment is highly effective, and the recurrence rate is low when managed early.

When Should You See a Doctor?

You should consult a dermatologist if you notice any unusual skin patch that:

Lasts more than 4 to 6 weeks
Changes in size, shape, or colour
Starts itching, bleeding, or crusting
Doesn't respond to the creams
Early medical attention can make all the difference in preventing progression into a more serious skin cancer.

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Recovery and Long-Term Outlook

Most people with Bowen's disease recover well, especially if diagnosed and treated early. The affected skin may take a few weeks to heal completely after treatment, depending on the method used.

Scarring is minimal with topical treatments and PDT, but may be more noticeable after surgery. Follow-up visits are important to monitor for recurrence or the appearance of new lesions.

People with a history of Bowen's disease should continue routine skin checks, use sun protection diligently, and avoid known risk factors.

How to Prevent Bowen's Disease?

Prevention focuses on protecting the skin and reducing exposure to harmful environmental triggers. Here's how:

Use broad-spectrum sunscreen daily, even on cloudy days.
Wear protective clothing such as hats and long sleeves when outdoors.
Avoid tanning beds and excessive sunbathing.
Stop smoking, which impairs skin health and healing.
Get HPV vaccination (where appropriate), especially for genital health.
Schedule regular skin exams with a dermatologist, especially if you're over 50 or at higher risk.

Expert Care for Bowen's Disease

At Medicover Hospitals, we offer specialised care for early skin cancers like Bowen's disease. Our expert dermatology team uses advanced diagnostic tools and evidence-based treatments to ensure quick, safe, and effective care.

Whether you need a skin biopsy, topical therapy, or a minor procedure, we provide a patient-first approach to your needs. Trust Medicover for compassionate, timely care that helps you protect your skin and your health.

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