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Bowen's disease

Bowen's disease is a very early form of squamous cell skin cancer. It's also called squamous cell carcinoma in situ. It's a very slow growing cancer.  

Doctors call Bowen's disease pre invasive. That means that there are cancer cells there, but they are only in the outermost layer of skin, the epidermis. Sometimes it can spread along the skin surface.

If left untreated, there is a small chance that Bowen's disease can spread into the deeper layers of the skin. This means it has become an invasive cancer called squamous cell carcinoma. So because of this your doctor either treats or monitors the disease. 

Like squamous cell cancer of the skin, Bowen's disease can grow anywhere. It is most common on the:

  • head and neck 
  • trunk
  • arms
  • legs

Risks and causes

In many cases of Bowen's disease, we don't know what has caused it. But it's most often related to sun exposure or use of sunbeds over a long period of time. But as it can occur in areas of the body not normally exposed to the sun, this is not the only cause.

Other possible links include people who have a weak immune system. This could be because they have an illness affecting their immune system. For example, acquired immune deficiency syndrome (AIDS). Or they might be taking medicines to lower their immune system. For example, after having an organ transplant such as a liver or kidney transplant. 

One type of Bowen's disease is called bowenoid papulosis. It's associated with a type of virus called human papillomavirus (HPV) 16. This type of HPV is also associated with cervical cancer and cancer of the penis.

Another link is arsenic ingestion through drinking contaminated water. But this is not something that happens nowadays. 

Symptoms

Usually, Bowen's disease appears as red scaly patches. Sometimes they look like raised spots or warts. Often the affected skin looks red and sore.

Bowenoid papulosis usually occurs on the pubic or genital area in men and women. This appears as brown or dark brown patches. When Bowen's disease is found in the vulval area (the outside parts of a woman's genitals) or in the mouth, there can be white patches on the skin called leukoplakia. 

Another symptom of Bowen's disease is itching. But often there are no symptoms apart from a patch on the skin. In some cases, the affected skin may become sore and bleed.

Treatment

There are several treatments for Bowen's disease, such as:

  • imiquimod cream
  • chemotherapy creams which are put straight onto the affected skin
  • freezing with liquid nitrogen
  • surgery
  • photodynamic therapy (PDT) - a special light and light sensitive drug are used to kill cancer cells
  • radiotherapy
  • laser

All these treatments can work well. The treatment you have will often depend on which part of your body is affected. Because there are many treatments, and because this is a very early type of skin cancer, the cure rates are high.

Last reviewed: 
25 Sep 2019
  • British Association of Dermatologists' guidelines for the management of squamous cell carcinoma in situ (Bowen’s disease)
    C A Morton and others
    British Association of Dermatologists, 2014. Volume 170, Issue 2, Pages 245 - 260.

  • Interventions for cutaneous Bowen’s Disease (Review)
    F J Bath-Hextall and others
    Cochrane Database of Systematic Reviews, 2013. Issue 6.

  • Arsenic Factsheet
    World Health Organization, February 2018.

  • Bowen’s Disease (Squamous Cell Carcinoma In Situ) Patient Information Leaflet
    British Association of Dermatologists, January 2017.

  • Cutaneous Bowen’s Disease: an Analysis of 182 Cases according To Age, Sex, and Anatomical Site from an Italian Center
    M Scalvenzi and others
    Open Access Macedonian Journal of Medical Sciences, 2019. Volume 7, Issue 4, Pages 696 – 697.

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact patientinformation@cancer.org.uk with details of the particular issue you are interested in if you need additional references for this information.

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