Bowens Disease

Overview

Bowen's disease is a very early form of skin cancer. It stays only in the top layer of skin and has not spread deeper. It looks like a red, scaly patch and grows very slowly. Doctors sometimes call it squamous cell carcinoma in situ. 'In situ' means the abnormal cells are still in their original place.

Bowen's disease is fairly common, especially in older adults. It is one of the most common early skin cancer patches seen in general practice.

It mainly affects people over 60. It is more common in people with fair skin, a history of sunburn, or a weakened immune system. Men are slightly more affected than women. It is very rare in children.

Symptoms

Common symptoms

• A slow-growing red, scaly patch of skin
• The patch may be flat or slightly raised
• It can be dry, crusty, or itchy, but is usually not painful
• It may look a little like psoriasis or eczema
• It usually appears on sun-exposed areas: lower legs, face, neck, hands, and scalp
• A single patch, or sometimes more than one, can be over a centimetre wide

Symptoms in children

• Bowen's disease is extremely rare in children.
• If a child has a suspicious patch, it is usually linked to a rare immune problem or a genetic condition.
• Any new, changing or unusual skin patch in a child should be checked by a doctor.

Symptoms in older adults

• The patch looks the same but may be larger or have a scaly crust.
• It is often found on the lower legs, head or neck, as these areas tend to get the most sun over a lifetime.
• Older adults may have more than one patch at different places on the body.

Causes

Main causes

• Long-term exposure to ultraviolet (UV) radiation from the sun or tanning beds
• Damage to the skin from years of sunburn
• A weakened immune system due to illness or medicines
• Past exposure to arsenic, which is rare but can be in some well water or old pesticides
• In some cases, infection with certain types of human papillomavirus (HPV)

Risk factors

• Fair skin, light hair, or light eyes
• Being 60 years of age or older
• A history of frequent sun exposure or sunburn
• Having used tanning beds
• Having had other skin cancers
• Taking medicines that suppress the immune system
• Having an organ transplant

When to see a doctor

See a doctor urgently if:

• See a doctor the same day if a skin patch changes quickly, becomes a lump, bleeds, or develops an ulcer.
• If you have signs of infection such as spreading redness, heat, or fever, seek care urgently.

Book a routine appointment if:

• Make a routine appointment if you have a red, scaly patch that lasts more than a few weeks or gets bigger.
• Also see your doctor if you notice a patch on your skin that looks different from your other spots and does not go away.

Diagnosis

A doctor will examine the skin patch and ask about your sun history and any symptoms. Usually they will take a small sample of skin, called a biopsy, to be absolutely sure.

Tests that may be done

• Skin biopsy: a doctor numbs the area, removes a small piece of skin, and sends it to a laboratory for testing

What to expect at your appointment

A skin biopsy is quick and done in the doctor's office. You may feel a small pinch from the numbing injection. The lab results take about a week. The report will confirm whether it is Bowen's disease or another skin condition, and this guides the best treatment.

Treatment

Treatment aims to remove or destroy the abnormal cells. The right option depends on the size, location, and number of patches, as well as your general health. Most treatments are done in a clinic and have a very high success rate.

Self-care at home

• Protect the treated area from sunlight and follow your doctor's after-care advice
• Keep the skin clean and dry until it heals
• Avoid picking at the patch or its scab
• Wear sunscreen and protective clothing every day
• Do monthly self-checks of your skin

Medical treatments

Medical treatments include freezing the patch, scraping and sealing it, removing it with a small surgical cut, or applying a prescription cream to the skin. Another option is photodynamic therapy, where a special light is used after a cream is applied to make the abnormal cells sensitive to light. Your doctor will explain the choices and help you decide which is best for you.

When is surgery considered?

Surgical removal is often used when the patch is large, or when the biopsy shows something that needs clearer margins. This means the doctor cuts out the patch along with a small border of healthy skin and stitches the area closed. It is a short, safe procedure done under local anaesthetic.

Living with this condition

After treatment, most people can go back to normal activities immediately or within a few days. You may have a small wound or scab, which heals within a couple of weeks. You will need to keep checking your skin and attend follow-up visits as advised.

Lifestyle tips

• Use high factor sunscreen every day, even when cloudy
• Wear a hat, long sleeves, and sunglasses when outdoors
• Avoid sunbeds and intentional tanning
• Check all your skin, including your back and scalp, once a month
• Ask a partner or friend to check difficult-to-see areas

Diet and exercise

Eating a balanced diet with plenty of fruit and vegetables provides nutrients that help keep your skin healthy. Regular physical activity and not smoking also help your body heal and stay strong.

Mental health and emotional wellbeing

It is completely normal to feel anxious or worried when a doctor mentions skin cancer. Remember that Bowen's disease is a very early and treatable condition. If you feel stressed or low, talk with your doctor or call a trusted support line. You don't have to manage these feelings alone.

Prevention

You can lower your risk of Bowen's disease by protecting your skin from ultraviolet (UV) radiation. This includes using broad-spectrum sunscreen, wearing sun-protective clothing, seeking shade during the strongest sun, and avoiding tanning beds. Checking your skin regularly also helps you spot changes early.

Vaccines

There is no specific vaccine to prevent Bowen's disease. However, practising good sun safety is the most effective prevention.

Screening programmes

There is no national screening programme for Bowen's disease. But you can perform a simple self-check once a month using a mirror. Look for any new or changing spots, red scaly patches, or sores that don't heal.

Complications

If left untreated

• Without treatment, a very small number of Bowen's disease patches can slowly turn into a more invasive squamous cell skin cancer.
• Invasive skin cancer can grow deeper into the skin and, rarely, spread to other parts of the body.

Long-term outlook

The outlook is excellent. Bowen's disease is caught while it is still on the skin's surface, and treatment is very effective. Most patches are cured with one course of treatment. After treatment, you simply need to keep an eye on your skin and protect it from the sun. You can live a full and normal life.

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