What is Bowen's disease?

Bowen's disease is a very early form of skin cancer. The cancer is on the top layer of your skin. It has not spread to the layers under the skin.

Bowen's disease is also called 'squamous cell carcinoma in situ'. Squamous cells are the flat cells that make up the top of the skin. 'In situ' means the cancer is localised in its original place.

Bowen's disease is not usually serious and there are treatments available. However, it should not be ignored. This is because there is a small chance it could change into a more serious form of skin cancer and spread.

What are the symptoms of Bowen's disease?

Bowen's disease usually looks like a patch of red, scaly skin. It can grow anywhere on your body. It is most common on skin that is exposed to the sun, such as the:

• face
• neck
• head
• trunk
• arms
• lower legs

It can also be on your lips or inside your mouth. It could be around your genitals or anus.

The patch grows slowly over time. Sometimes the patch may become thicker, more scaly and look inflamed (sore). Sometimes it can look like an ulcer or a thickened scar.

The patch of skin is often itchy but sometimes there may be no symptoms.

There aren't usually any other symptoms. Bowen's disease is often mistaken for psoriasis, eczema or a fungal infection.

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What causes Bowen's disease?

Bowen's disease starts in the epidermis — this is the top, outer layer of skin. Most cases of Bowen's disease are caused by exposure to sunlight.

Some people are more at risk of getting Bowen's disease. It is more common in:

• those with suppressed immune systems
• people who have been exposed to arsenic
• those exposed to radiation

Bowen's disease in the mouth, genital or anal areas is often associated with human papilloma virus (HPV) infection.

People with Bowen's disease often also have other forms of skin cancer such as basal cell carcinoma.

When should I see my doctor?

If you notice a new or changing mole, freckle or spot, you should see your doctor. They will examine you. They may refer you to a dermatologist (skin specialist).

See your doctor if your notice any changes to your skin. A skin change could be:

• a thickened, red scaly spot
• a spot or patch of skin that starts to bleed easily or crust
• a patch of skin that looks different or develops a lump

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How is Bowen's disease diagnosed?

A doctor can diagnose Bowen's disease by looking carefully at the affected patch of skin.

Most people will need a biopsy. This is when a small sample of tissue is removed to be examined in a laboratory. The biopsy can confirm the diagnosis.

How is Bowen's disease treated?

There are many ways to treat Bowen's disease. Because it is such an early cancer, it can usually be cured.

The best type of treatment for you will depend on:

• the size and thickness of the Bowen's disease
• where it is on your body
• your age
• your health in general

You can choose what treatment to have. Sometimes, Bowen's disease comes back after treatment. It is important to go to follow-up appointments with your doctor or dermatologist.

Freezing it off (cryotherapy)

Liquid nitrogen is sprayed onto the patch of skin to freeze it. It will scab over and fall off after a few days. This procedure can be a little uncomfortable.

Chemotherapy cream

A medicine such as 5-fluorouracil or imiquimod is put on the patch. You need to use the cream regularly for a few weeks. The skin often gets red and inflamed before it gets better.

Curettage and cautery

You are given a local anaesthetic. Then the patch of skin is scraped away. Heat or electricity are used to stop any bleeding.

Photodynamic therapy (PDT)

A cream that reacts to light is spread on the patch of skin. Then a laser is shone on the area a few hours later to kill the cancer cells. This may need to be repeated.

Surgery

You are given a local anaesthetic. Then the patch is cut out. You may need stitches afterwards.

Can Bowen's disease be prevented?

It's very important to protect yourself from sun exposure to prevent skin cancers developing.

You should also have your skin checked by a doctor at least once a year.

Complications of Bowen's disease

If Bowen's disease is not treated, a there is a chance it could become an invasive skin cancer called a squamous cell carcinoma. That means it can spread locally or to other parts of the body.

Resources and support

Cancer Council Australia has information about skin cancer and you can call them for support on 13 11 20.

SunSmart has accessible information about skin cancer and skin cancer prevention.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.