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' (SCC in situ). Squamous cells are the flat cells that make up the top layer of the skin. 'In situ' means the cancer has not spread.

Bowen's disease is not usually serious and there are many 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 your:

• neck
• head
• trunk
• arms
• hands
• lower legs

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

The patch grows slowly over a long time. Sometimes the patch may become thick, scaly and red (inflamed). It can also look like an ulcer or a thickened scar.

The patch of skin can be itchy but usually there are no symptoms.

Bowen's disease can be mistaken for psoriasis, eczema or a fungal infection.

What causes Bowen's disease?

Bowen's disease starts in the top, outer layer of skin, called the epidermis. 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 if you:

• have a lowered immune system
• have been exposed to arsenic
• have been exposed to radiation

Bowen's disease in the mouth, genital or anal areas is often caused by human papillomavirus (HPV) infection.

People with Bowen's disease sometimes also have other forms of skin cancer, such as basal cell carcinoma (BCC).

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 and ask you some questions. They may refer you to a dermatologist (skin specialist).

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

• a thickened, red scaly spot
• a spot or patch of skin that bleeds easily or crusts
• a patch of skin that looks different or develops a lump

How is Bowen's disease diagnosed?

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

Your doctor may send a small sample of tissue analysis to a lab, known as a biopsy.

The biopsy can confirm the diagnosis.

How is Bowen's disease treated?

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

The best type of treatment for you will depend on:

• the size and thickness
• where it is on your body
• your age
• your health in general

You can usually choose from a number of treatments. 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. It can be done quickly at the doctor's office.

This procedure can be a little uncomfortable and take longer to heal. There is a higher chance of Bowen's disease coming back with this treatment. It can leave a white spot, so it is not recommended if the patch is on your face or on darker skin.

Chemotherapy cream

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

A biopsy is needed before starting this treatment. You may not be able to use these medicines if you have a lowered immune system or other skin conditions, such as psoriasis or eczema.

It can be used when surgery is not practical because of location or large size. It can also be used for areas that take a long time to heal.

Curettage and cautery

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

This can be done on smaller patches and can be quickly done in the doctor's office. It is also less expensive and has good cosmetic results with only a small scar. There is a small chance of infection or bleeding afterwards.

Photodynamic therapy (PDT)

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

PDT is good if you have multiple or large patches. It can also be used for patches in areas that take longer to heal.

This treatment requires special training and equipment, so it may not be available in all clinics. There may be discomfort, redness and itch for a week.

Surgery

You are given a local anaesthetic. The patch is then cut out and closed, sometimes with stitches. Your doctor may need to use skin from another part of your body to cover the area.

This may be considered if the patch is very thick or if it extends down into hair follicles.

What are the complications of Bowen's disease?

If Bowen's disease is not treated, there is a chance it could become a serious skin cancer called a squamous cell carcinoma. If this happens, it may spread locally or to other parts of the body.

Can Bowen's disease be prevented?

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

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

Resources and support

Cancer Council Australia has information about skin cancer. Call them for support on 13 11 20.

SunSmart has information about skin cancer and skin cancer prevention.

The Royal Children's Hospital Melbourne has information on how to keep children sun safe.

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 you 24 hours a day, 7 days a week.

Languages other than English

The New South Wales (NSW) Government has information on sun safety available in many community languages.

Cancer Council Queensland offers a skin cancer fact sheet in several languages.

Information for Aboriginal and/or Torres Strait Islander peoples

Our Mob and Cancer has information on sun protection.

Cancer Council NSW has information on skin cancer available for Aboriginal and/or Torres Strait Islander peoples.