Bowen's disease
Bowen’s disease is a skin condition that can sometimes develop into skin cancer if it is not treated.
What is Bowen’s disease?
Bowen’s disease is a growth of abnormal cells in the outer layer of the skin (epidermis). It often appears as a red, scaly area on the skin. It is not a serious condition and there are many effective treatments. The cells are only in the outer layer of the skin. They grow very slowly and are unlikely to cause a problem in most people.
Bowen’s disease is also called squamous cell carcinoma in situ. It is sometimes called a pre-cancerous condition. If it is not treated, it can sometimes develop into a type of skin cancer called squamous cell carcinoma (SCC).
Researchers think that 3 out of every 100 people with Bowen’s disease (3%) might go on to develop SCC over time. This means that 97 out of every 100 people who have Bowen’s disease (97%) do not develop SCC.
SCC is a common, curable type of skin cancer. It affects the epidermis. But it can spread to deeper layers. If left untreated for a long time, SCC can spread to other parts of the body.
The structure of the skin
Bowen’s disease risk factors
Bowen’s disease usually affects people in their 60s and 70s.
Bowen’s disease has most often been linked to long-term sun exposure. This risk is higher if you have fair skin or tend to burn easily in the sun. It has also been linked to having a weakened immune system or having had radiotherapy in the past.
Occasionally, Bowen’s disease can affect the genital area. This is usually linked with a common type of virus called the human papilloma virus (HPV). HPV may also be linked with Bowen’s disease on the hands or feet. There are different types of HPV. Some are linked with other cancers, such as cervical cancer.
Rarely, long-term exposure to a chemical called arsenic can cause Bowen’s disease.
Bowen’s disease is not infectious and cannot be passed from one person to another.
Bowen's disease symptoms
Bowen’s disease can occur anywhere on the body. But it is usually found on areas that have been regularly exposed to the sun. These include the:
- face
- scalp
- neck
- hands
- lower legs.
Bowen’s disease often starts as a patch of skin that is:
- scaly
- red or pink – this can be harder to see on black or brown skin.
Sometimes the area can look like raised spots or warts. It may become itchy or sore, and it may bleed. Bowen’s disease can look like other skin conditions, such as eczema or psoriasis. It is always important to get any skin problems checked by a doctor to be sure of the cause.
Bowen’s disease diagnosis
If your GP thinks you might have Bowen’s disease, you will be referred to a doctor who specialises in skin problems. They are called a dermatologist. They will examine your skin and may be able to diagnose it from the way it looks. They may also take a sample of skin to confirm the diagnosis. This is called a biopsy.
Before you have a biopsy, a doctor will numb the area with a local anaesthetic. They will remove a small piece of the affected skin and examine it under a microscope.
Ask your doctor when your results will be available and how you will get them.
Bowen’s disease treatment
There are many different treatments for Bowen’s disease. The treatment you have depends on:
- where the area of Bowen’s disease is on the body
- its size and thickness
- the number of affected areas
- any previous treatment you may have had for Bowen’s disease.
The treatment you have also depends on how well the skin is likely to heal afterwards. For example, skin on the lower legs tends to be more fragile, especially in older people. This means it may not heal well.
Some treatments may be more suitable than others, depending on your situation. Your doctor will discuss with you which treatment might be best.
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Drug cream treatments
You may have treatment in a cream or lotion that you put directly on the affected area.
Drug cream treatments used for Bowen’s disease include:
- fluorouracil or 5FU (Efudix®)
- imiquimod (Aldara®).
These treatments are also used to treat some types of skin cancer.
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Photodynamic therapy (PDT)
Photodynamic therapy (PDT) uses a skin cream that is activated by light to treat the affected area. If you have large areas of Bowen’s disease, PDT may be a treatment option .
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Cryosurgery
If the affected area is very small, it may be possible to treat Bowen’s disease by freezing it. This is called cryotherapy or cryosurgery. A dermatologist will carefully spray liquid nitrogen onto the area to freeze and destroy the abnormal cells.
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Curettage and electrocautery
Curettage is when a skin specialist doctor (dermatologist) scrapes away the affected area. They then use heat or electricity to stop any bleeding. This is called electrocautery.
Before treatment, the doctor gives you a local anaesthetic to numb the area. Then they scrape away the area, using an instrument called a curette. They use an electrically heated loop or needle to stop the bleeding from the wound and destroy any remaining abnormal cells. The wound usually heals within a few weeks and leaves a scar.
This treatment may be suitable for small patches of Bowen’s disease.
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Surgery
Doctors may use surgery to remove areas of Bowen’s disease , using a local anaesthetic. Surgery may be used to remove deeper areas, or if other treatments have not been successful.
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Laser treatment
Laser treatment uses intense light energy to remove tissue. It is sometimes used to treat Bowen's disease that affects the fingers or genitals. Doctors are carrying out research trials to find out how effective this treatment is in the long term.
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Radiotherapy
Radiotherapy uses high-energy x-rays to treat abnormal cells. It is sometimes used if Bowen’s disease is causing symptoms such as pain or bleeding. Doctors may also use it on areas that come back after treatment. It is not usually used on areas where the skin takes longer to heal, such as the lower legs.
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Observation and monitoring
Bowen’s disease often grows very slowly, over a period of months or years. Sometimes a thin patch of Bowen’s that does not change will never cause a problem. In this case, your dermatologist may advise you to keep checking it for changes instead of giving you treatment. You may also have regular check-ups with your doctor to monitor it carefully.
Monitoring can be a good option if you are likely to have problems with skin healing after treatment.
Tell your dermatologist if you:
- notice any changes to the patch of Bowen’s disease
- develop an ulcer (sore) on the patch of Bowen’s disease.
Follow-up after treatment for Bowen’s disease
After treatment, you may only need to see your GP for a check-up. If any new skin changes develop, you may need to have these checked by your dermatologist.
If you have had treatment at hospital, you may have regular follow-up appointments at the hospital where you were treated. Your doctor will check your skin for any further changes that may need treating. Contact your doctor or nurse at the hospital if:
- you notice any changes to the patch of Bowen’s disease
- a new patch develops between appointments.
If you are not being seen regularly by a dermatologist, it is important to keep checking your skin yourself. Tell your GP if you develop new patches or have any other skin symptoms.
Protecting your skin
If you have had Bowen’s disease, it is even more important to protect yourself from the sun and avoid sunburn. We have more information about how to stay safe in the sun.
Your feelings
You may feel anxious about being diagnosed with Bowen’s disease, or having treatment and its impact on your appearance. Everyone’s reactions are different, and you might have a mixture of emotions.
Talking about your feelings can be helpful. You may find it helpful to talk things over with your family, friends, doctor or nurse. Sometimes it is easier to talk to someone like a professional counsellor. If you are finding it difficult to cope, your specialist doctor or GP can usually refer you to a counsellor who can help.
You may have some minor scarring from the treatment. Although this usually improves with time, you may feel self-conscious about how you look. We have more information if Bowen’s disease has affected your body image.
About our information
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References
Below is a sample of the sources used in our skin cancer information. If you would like more information about the sources we use, please contact us at informationproductionteam@macmillan.org.uk
Keohane SG, Botting J, Budny PG, et al. British Association of Dermatologists guidelines for the management of people with cutaneous squamous cell carcinoma 2020. The British Journal of Dermatology. 2021;184(3): 401–414. Available from www.doi.org/10.1111/bjd.19621 [accessed May 2024].
Nasr I, McGrath EJ, Harwood CA, et al. British Association of Dermatologists guidelines for the management of adults with basal cell carcinoma 2021. The British Journal of Dermatology. 2021;185(5): 899–920. Available from www.doi.org/10.1111/bjd.20524 [accessed May 2024].
Sharma A, Birnie AJ, Bordea C, et al. British Association of Dermatologists guidelines for the management of people with cutaneous squamous cell carcinoma in situ (Bowen disease) 2022. The British Journal of Dermatology. 2023;188(2): 186–194. Available from: www.doi.org/10.1093/bjd/ljac042 [accessed May 2024].
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Reviewers
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Professor Samra Turajlic, Consultant Medical Oncologist.
With thanks to: Dr Stephanie Arnold, Consultant; Kerry Jane Bate, Advanced Nurse Practitioner; Dr Philippa Closier, Clinical Oncologist; Sharon Cowell-Smith, Macmillan Advanced Nurse Practitioner Skin Cancers; and Dr Benjamin Shum, Medical Oncologist.
Thanks also to the other professionals and people affected by cancer who reviewed this edition, and to those who shared their stories.
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