Bowen’s Disease

Bowen’s disease was named for the doctor, John T. Bowen, who first described the skin disease in 1912. It is now also known as squamous cell carcinoma in situ, or SCC in situ. “In situ” means the cancer is in its original place or position, and squamous cell carcinoma in situ refers to a skin cancer that develops from the squamous cells (the cells in the middle and outer layers of the skin) and that has not spread beyond the surface. Conversely, invasive squamous cell carcinomas grow inward and may spread to other parts of the body.1,2

Symptoms of Bowen’s disease

Bowen’s disease, or SCC in situ, appears as a red plaque on the skin with a scaling or crusted surface. The lesion has a well-defined border and may enlarge slowly. Bowen’s disease is most commonly found on the lower limbs, on the head and neck, although it can occur in the genital region, on the palms of the hands, or on the skin around fingernails or toenails. Bowen’s disease usually appears as a solitary lesion, but in 10-20% of cases, there are multiple sites. In about 3-5% of cases (and 10% of genital lesions), Bowen’s disease can progress into an invasive cancer, so proper diagnosis and treatment are important to prevent the spread of this form of skin cancer.1,2


Bowen’s disease is more common among Caucasian people. It has been found to have several causes, including:

  • Ultraviolet (UV) radiation exposure, including from sunlight and artificial sources
  • Exposure to arsenic, which is found in certain pesticides an in former treatments for conditions like psoriasis and asthma
  • Human papillomavirus (HPV)
  • Immunosuppression, which may be induced (such as after organ transplantation) or may occur as a result of a condition like AIDS (acquired immune deficiency syndrome)

Other possible causes that may influence the development of Bowen’s disease include genetic factors, trauma, exposure to other chemical carcinogens, and x-ray radiation.1,2

Treatment options

Treatment for Bowen’s disease depends on many factors, including the site of the lesion(s), the number of lesions, the size and thickness of the lesion(s), the patient’s age and health status, the cosmetic outcome, and the patient’s preference. Treatment options include:

  • Cryotherapy - the use of liquid nitrogen to freeze the infected area
  • Curettage with cautery – a procedure in which the lesion is removed with a sharp blade called a curette and cauterized to stop the bleeding and seal the wound
  • Mohs surgery – a procedure in which the skin cancer is removed layer by layer and each layer is examined under a microscope to determine if the margins are clear of cancer, indicating all the cancer cells have been removed
  • 5-fluorouracil (5-FU) – a cream that contains an anti-cancer drug
  • Radiotherapy, or radiation therapy – the use of targeted x-rays to destroy the cancer cells
  • Laser ablation – the use of laser to burn off the lesion
  • Photodynamic therapy (PDT) – use of a special light that activates a cream that has been applied to the lesion
  • Imiquimod – a topical cream that works by modifying the immune response2,3
  • Diclofenac – a topical gel that is used to treat actinic keratosis and may be used for
    Bowen’s disease2

Recurrence and follow up

There is a 10% recurrence rate in Bowen’s disease, and people who have had Bowen’s disease should receive regular follow-up care. As with other forms of skin cancer, total body skin examinations are recommended every 6-12 months.1,2

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