What is Bowen’s disease?
Bowen’s disease (morbus Bowen) is a condition in which abnormal cells are present very superficially in the skin. It is regarded as the last stage before skin cancer, which is why it is also called squamous cell carcinoma in situ — loosely, squamous cell carcinoma “in the bud”. The lesion often first spreads superficially, and it can take a long time before actual skin cancer develops from a Bowen’s disease.
What does it look like?
Bowen’s disease looks like a red, often slightly scaly patch that is fairly sharply bordered from the healthy skin. It is often initially mistaken for a patch of eczema, and can also strongly resemble a superficial basal cell carcinoma. It usually causes no itch or pain. It is seen mainly on parts of the skin regularly exposed to the sun, such as the hands, forearms and face.
How is it treated?
Because the abnormal cells lie very superficially, there are (besides surgical removal) several other treatment options:
- Nitrogen therapy — freezing with liquid nitrogen is a quick and often effective method.
- 5-fluorouracil cream — often effective; you apply the cream yourself twice a day for a number of weeks (usually 3 or 4).
- Photodynamic therapy — the abnormal cells are made sensitive to visible light with a special cream, then illuminated so the cells die and the Bowen’s disease is cleared.
When the doctor has any doubt about whether it might be an early skin cancer, surgical removal is preferred.
What is the outlook?
Treatment of Bowen’s disease is straightforward. Most dermatologists advise having the skin screened yearly by the doctor for Bowen’s disease and other skin damage.
When to see a doctor
See a doctor for a persistent red, scaly patch that does not respond to eczema treatment, especially on sun-exposed skin, so Bowen’s disease can be treated and skin cancer ruled out.