Bowen’s disease is an early form of skin cancer that appears as a persistent red, scaly patch. It is highly treatable but can develop into invasive skin cancer if left untreated.
Bowen’s disease, also known as squamous cell carcinoma in situ (SCC in situ), is a growth of abnormal cancerous cells confined to the outermost layer of the skin. The abnormal cells have not spread deeper into the skin or other parts of the body. For this reason, it is considered an early-stage skin cancer with an excellent prognosis when identified and treated appropriately.
The condition usually develops slowly over months or years and may remain stable for long periods. However, medical assessment is important because a small proportion of untreated lesions can develop into invasive squamous cell carcinoma.
IMPORTANT: Bowen's disease can vary significantly in appearance from person to person. Clinical images are provided as examples only and may not represent every case. Lesions may appear red, pink, brown, crusted, scaly, flat or slightly raised, and can sometimes resemble eczema, psoriasis or other non-cancerous skin conditions. A diagnosis cannot be made from photographs alone and should be confirmed by a qualified clinician.
Bowen’s disease is a relatively common form of non-melanoma skin cancer, particularly in older adults. It is most frequently diagnosed in people over the age of 60 and is more common in areas of skin that have received significant sun exposure over many years.
Several factors can increase the risk of developing Bowen’s disease, including:
Bowen’s disease can develop anywhere on the body but is most commonly found on:
Less commonly, it can affect the groin or genital area.
Bowen’s disease itself is usually not dangerous because the abnormal cells remain confined to the surface layer of the skin. However, if left untreated, a small percentage of lesions can progress into invasive squamous cell carcinoma, which has the potential to spread deeper into surrounding tissues and, in rare cases, elsewhere in the body.
Bowen’s disease most commonly presents as a persistent patch of abnormal skin with clearly defined edges.
Typical features include:
The patch may be only a few millimetres in size initially but can gradually increase in diameter if untreated.
Changes that may indicate progression include:
Any of these changes should be assessed promptly by a healthcare professional.
The most common cause is cumulative ultraviolet (UV) damage to skin cells over many years. UV radiation damages DNA within skin cells, increasing the risk of abnormal cell growth.
Other contributing factors may include:
Diagnosis begins with a clinical skin examination. A clinician will assess the lesion’s size, shape, colour, texture and duration, as well as any recent changes.
Because Bowen’s disease can resemble conditions such as eczema, psoriasis or other skin lesions, further assessment is sometimes required.
A skin biopsy may be performed if the diagnosis is uncertain or if there is concern that the lesion may have progressed beyond the surface layer of the skin.
The biopsy allows the tissue to be examined under a microscope and can confirm the diagnosis.
Many clinicians use dermoscopy, a specialised magnifying device that helps assess skin lesions in greater detail and can improve diagnostic accuracy.
Treatment aims to remove or destroy the abnormal cells and prevent progression to invasive skin cancer.
The most appropriate treatment depends on:
Treatment may include:
Yes. Although treatment is usually successful, recurrence can occur. People who have had Bowen’s disease may also be at increased risk of developing additional skin cancers in the future.
Regular skin monitoring and prompt assessment of new or changing lesions are recommended.
The outlook for Bowen’s disease is excellent when diagnosed and treated early. Because the abnormal cells remain confined to the epidermis, treatment is highly effective in most cases.
Most people recover fully following treatment, although follow-up appointments may be recommended depending on the lesion type, location and individual risk factors.
Bowen’s disease cannot always be prevented, but the risk can be reduced by limiting ultraviolet (UV) exposure and protecting the skin from sun damage.
Helpful measures include:
Early detection remains one of the most effective ways to reduce the risk of complications from Bowen’s disease and other forms of skin cancer.
If you have a patch of skin that is not healing, continues to grow or has changed in appearance, arranging a professional skin assessment can help identify Bowen’s disease and other skin conditions at an early stage.
