Bowen's disease (also called squamous cell carcinoma in situ) is a slow-growing and red, scaly skin patch, most commonly found on the lower leg. Although the cause of this very early form of skin cancer is unknown, sun exposure is an important risk factor. Treatment options include surgical excision, cryosurgery, curettage, medicated ointments and photodynamic therapy.
Bowen’s disease is a very early form of skin cancer that appears as a slow-growing, red and scaly skin patch. In Bowen’s disease, the skin cancer is located only in the epidermis, the uppermost layer of the skin. Rarely, the skin cancer can invade into the dermis and then it is called an invasive squamous cell carcinoma.
Bowen’s disease can occur on any part of the body, although the lower legs are most commonly affected. It is easily mistaken for psoriasis, another skin complaint characterised by scaly patches.
Fair skin and exposure to sunlight are the main risk factors for Bowen’s disease. Women are more susceptible than men and most cases occur in people over 40 years. The condition isn’t contagious and treatment is usually successful.
Signs of Bowen’s disease
The signs of Bowen’s disease include:
- Flat, scaly, red and slightly raised patches appear.
- A single patch or a number of patches may be present.
- The edges of each patch are irregular but distinct from the surrounding skin.
- The patch or patches grow very slowly.
- The patches present no symptoms, so they are often overlooked.
- The patches can affect any part of the body, but commonly occur on the lower leg.
- Occasionally, the patches can be sore, irritated or bleed.
Bowen’s disease may turn cancerous
In most cases, Bowen’s disease remains confined to the upper layer of the skin (epidermis). However, if left untreated, the affected cells may migrate deeper into the skin layers. If a patch of Bowen’s disease becomes raised, tender or is bleeding, then it will need immediate medical attention.
Risk factors for Bowen's disease
The cause of Bowen’s disease is unknown, but suspected risk factors include:
- Gender – the condition is more common in women.
- Age – the condition is more common in people over 40 years. Elderly women are particularly prone.
- Sun exposure – Bowen’s disease is more common in sunny countries. However, since areas of the body that are not normally exposed to sunlight (such as the genitals or anus) can be affected, sun exposure can’t be the sole risk factor.
- Arsenic – people who are exposed to arsenic are at increased risk.
- Systemic immunosuppression - required by organ transplant recipients to prevent organ rejection.
Diagnosis of Bowen's disease
Bowen’s disease is easily overlooked because the lesions present no symptoms. It is not unusual for Bowen’s disease to be diagnosed during a routine skin examination.
Diagnosis methods include:
- Physical examination
- Medical history
- Biopsy of the lesion, including laboratory examination of the tissue sample.
Treatment for Bowen's disease
Treatment options include:
- Cryosurgery – the lesion is destroyed with intense cold. This type of treatment has a success rate of around 90 per cent when conducted by specialists.
- Curettage – the lesion is scraped off the skin. It may be used with cauterisation, where the skin is lightly burnt with an electric current. It has a success rate of around 90% when performed by dermatologists.
- Photodynamic therapy (PDT) – a special type of light is used to destroy the lesion. Success rates are in the order of 80 per cent with a specialist.
- Topical creams – applied to the lesion to kill its cells. These include 5-fluorouracil cream and imiquimod cream. Success rates are similar to PDT.
- Surgery – the lesion is cut out and the wound sutured closed. This treatment has a near 100 per cent success rate, but will leave a surgical scar.
- Radiation therapy – is rarely used now.
Where to get help
- Your doctor
Things to remember
- Bowen’s disease is a type of slow-growing and red, scaly skin patch.
- It is generally considered to be a pre-cancerous condition, with a small risk of turning into a skin cancer.
- The condition typically affects elderly women.
- Treatment options include cryosurgery, curettage, photodynamic therapy, medicated ointments and surgery.
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Last reviewed: June 2013
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