Bowen's disease is a very early form of squamous cell skin cancer, which is easily curable. The main sign is a red, scaly patch on the skin.
Squamous cells make up the single outermost layer of skin. Bowen's disease is sometimes referred to as 'squamous cell carcinoma in situ', as the cancerous cells are contained in this top layer.
Sometimes, the cancerous cells spread along the skin surface, but it is usually very slow-growing and may not change for years.
Only occasionally (in 3-5% of patients) does Bowen's disease invade the deeper layers of skin and turn into a type of skin cancer. This is only a risk if Bowen's disease is left undiagnosed or neglected.
Always see your doctor if you have a red, scaly patch of skin and don't know the cause. If necessary, your doctor will refer you to a dermatologist to determine the cause of your skin condition.
Bowen's disease can appear anywhere on the skin, especially the trunk, arms or legs.
It is most commonly found on the lower leg of elderly women (see 'who is affected', below).
Occasionally, it can affect the genital area. This type of Bowen's disease is known as bowenoid papulosis.
Bowen's disease usually appears as a persistent reddened scaly patch on the skin that is 1-3cm in diameter and which may or may not be itchy.
The affected skin can be red and sore and may bleed and scab.
Bowenoid papulosis appears as a brown patch around the groin area.
Bowen's disease is more common in women than men, and usually affects older people in their 70s-80s.
It tends to be seen on people who have had lots of sun exposure (one of the main causes), especially those with fair skin.
It's also more likely to affect people who take medication to suppress their immune system (for example, those who have just had an organ transplant).
The causes of Bowen's disease are often unknown. It doesn't run in families and you cannot pass it on to others. However, people with fair skin are more at risk of developing it.
Most cases develop as a result of long-term exposure to the sun. However, this is not the only cause, as Bowen's disease can develop in areas of the skin not normally exposed to the sun.
You are also more at risk of Bowen's disease if you have had radiotherapy in the affected area.
Rarely, it is related to arsenic exposure.
Bowenoid papulosis (affecting the genital area) may be caused by the same human papillomavirus that causes genital warts.
There are a number of options for treatment and your dermatologist will take into consideration where the patch is on your body as well as the size, thickness, and number of patches you have before deciding on the most appropriate procedure.
They will also consider how well your skin is likely to heal afterwards – for example, skin on the lower legs tends to be tight, fragile and slow to heal.
Treatment options include:
Talk to your dermatologist about which treatment may be most suitable for you.
In a minority of cases, your dermatologist may just advise monitoring the Bowen's disease closely, as it is very slow-growing and (because of the side effects of treatment) may not be worth treating.
After treatment, you may need follow-up appointments with your dermatologist or doctor to see if you need any further treatment.
If you had surgery to remove the patch followed by stitches, you will need to have the stitches removed by your doctor one to two weeks later.
In the meantime, if your patch starts to bleed or change in appearance or a new lump develops, see your doctor or nurse for advice immediately. Do not just wait for your follow-up appointment.
Always make sure you protect your affected skin from the sun – wear protective clothing and use a sunscreen with a high sun protection factor (SPF) of at least 30. Read more advice on staying safe in the sun.
Bowen's disease often grows very slowly, over a period of months or years. All the above treatments work well for Bowen's disease and the cure rates are high.
If Bowen's disease is not diagnosed and monitored, it can eventually turn into squamous cell cancer in a small number of people (about 3-5 in every 100 affected people). Read more about squamous cell skin cancer.
Important: Our website provides useful information but is not a substitute for medical advice. You should always seek the advice of your doctor when making decisions about your health.