Bowen’s disease looks like a red, scaly area or patch, on the skin. It is caused by the abnormal growth of cells in the outer layer of the skin (epidermis). The cells do not spread into the deeper layers of the skin. Bowen’s disease is more common in women. It usually affects people in their 60s and 70s.
Bowen’s disease is sometimes called squamous cell carcinoma in situ. If it is not treated, it can occasionally develop into squamous cell carcinoma (SCC). This happens in a small number of people (about 3 to 5 out of every 100 who have Bowen’s disease). SCC is a common, curable type of skin cancer. It affects the outer layer of the skin, but can spread to deeper layers. If left untreated for a long time, SCC can spread to other parts of the body.
Too much exposure to the sun over a long period of time is probably the most important risk factor for Bowen’s disease. But it can occur in areas that have not been exposed to the sun, so this is not the only cause.
People who have previously had radiotherapy in the affected area are also at risk of developing Bowen’s disease. Rarely, exposure to a chemical called arsenic can be the cause. People who have to take drugs that lower their immunity (for example, after a kidney transplant) are more at risk of getting Bowen’s disease.
Occasionally, Bowen’s disease can affect the genital area. This is usually linked with a common type of virus called human papilloma virus (HPV). HPV may also be linked with Bowen’s disease on the hands and feet. There are different types of this virus. Some are linked with other cancers, such as cervical cancer.
Bowen’s disease can occur anywhere on the body. But it is usually found on areas that are exposed to the sun. These include the face, neck or lower legs. To begin with, Bowen’s disease often looks like a red, scaly patch. Sometimes it can look like raised spots or warts. The affected skin may become itchy or sore and may bleed. Bowen’s disease can look like other skin conditions, such as eczema or psoriasis. So it is important to get any skin problems checked by a doctor.
If your GP suspects you might have Bowen’s disease, you will normally be referred to a doctor who specialises in the skin (dermatologist). They will examine your skin and use their experience to diagnose it. They may also take a sample of skin (biopsy).
Before you have a biopsy, the doctor will numb the area with a local anaesthetic. Then they will remove a small part of the affected skin. Once they have taken the sample, they will send it to a laboratory to be looked at closely under a microscope.
There are many different treatments for Bowen’s disease. The treatment you have will depend on:
- where the area of Bowen’s disease is on your body
- its size and thickness
- the number of affected areas you have.
An important factor when deciding which treatment you will have, is how well the skin is likely to heal afterwards. For example, skin on the lower legs tends to be more fragile, especially in older people. This means it may not heal as well, so some treatments may not be suitable.
A chemotherapy cream called 5-fluorouracil (Efudix®) may be used. It is also called 5FU. Chemotherapy is the use of anti-cancer drugs.
You put the cream onto the skin regularly over a period of time. Your nurse or doctor will tell you how often. It can make the skin in the area red and inflamed before the Bowen’s disease gets better. Usually there are no other side effects.
A cream called imiquimod (Aldara®) can also be used. It is a type of immunotherapy. This means that it works by using the immune system to attack the abnormal cells. You put it on the skin regularly over a period of time. It will cause some redness and skin irritation before the Bowen’s disease improves.
Curettage and electrocautery
This is when the doctor scrapes away the affected area (curettage). Then they use heat or electricity to stop any bleeding (electrocautery).
First the doctor will give you a local anaesthetic to numb the area. Then they scrape away the area using a spoon-shaped instrument called a curette. They use an electrically-heated loop or needle to stop the bleeding from the wound and destroy any remaining abnormal cells. After this treatment, a scar may develop.
This treatment may be suitable for small patches of Bowen’s disease.
Photodynamic therapy (PDT)
Photodynamic therapy is a treatment that is used for different conditions. It can be a useful option if you have large areas of Bowen’s disease. It uses light combined with a light-sensitive drug to destroy abnormal cells.
The doctor or nurse puts light-sensitive cream on the affected area. About 3 to 4 hours later, they shine a special light onto the area for about 10 to 15 minutes. The light destroys cells that have absorbed the cream.
Some people may find they get a stinging or burning feeling in the treatment area. Tell your doctor or nurse if you are uncomfortable. They can give you something to help.
Afterwards, the doctor or nurse will put on a dressing to cover the area and protect it from light. You may need more than one treatment. Your doctor will tell you how many you may need.
Doctors may use surgery for small areas of Bowen’s disease that can be removed under local anaesthetic. This is not always the best option for large patches of Bowen’s disease.
It may be possible to treat the area by freezing it. This is called cryotherapy or cryosurgery. The dermatologist will carefully spray liquid nitrogen onto the area to freeze the cells. It will feel very cold and a bit uncomfortable, but this should ease. Afterwards, you will have a scab, which usually falls off within a few days or weeks. This removes the affected skin. How quickly it heals depends on where it is. If the area is on your face, it may heal within 2 to 3 weeks. But other areas can take a bit longer.
Bowen’s disease often grows very slowly, over a period of months or years. You may have a thin patch of affected skin that is not changing. In this case, your dermatologist may advise you to just keep checking it for changes. You may also have regular check-ups to monitor it carefully.
Observation can be a good option if you are more likely to have problems with skin healing after treatment. Tell your dermatologist if you notice any changes or develop an ulcer (sore) on the patch of Bowen’s disease.
Laser treatment uses intense light energy to remove tissue. It is sometimes used as a treatment for Bowen's disease that affects the fingers or genitals. Doctors are carrying out research trials to find out how effective this treatment is in the long term.
Radiotherapy uses high energy x-rays to treat abnormal cells. It is sometimes used if you have Bowen’s disease that is causing symptoms, such as pain or bleeding. Doctors may also use it on areas that come back after treatment. It is not usually used on areas where the skin takes longer to heal, such as the lower legs.
You may have regular check-ups after treatment. At these follow-up appointments, the doctor will check your skin for any further changes that may need treating.
If you notice any changes to a patch of Bowen’s disease, or if a new patch develops between appointments, contact your doctor or nurse at the hospital.
If you aren’t being seen regularly by a skin specialist, it is important to keep checking your skin yourself. Tell your GP if you develop new patches or have any other skin symptoms. After treatment, many people with Bowen’s disease are just seen by their GP, unless any new skin changes develop.
Protecting yourself from the sun is even more important when you have had Bowen’s disease. Here are some tips for staying safe in the sun:
- Wear clothing made of cotton or natural fibres that have a close weave. These will give you more protection against the sun.
- Keep your arms and legs covered by wearing long-sleeved tops and trousers.
- Protect your face and neck with a wide-brimmed hat.
- Always wear sunglasses in strong sunlight. Look for glasses with the CE mark.
- Use suncream with a high sun protection factor (SPF) of at least 30, and 4 or 5 stars. Follow the instructions on the bottle and re-apply as recommended, particularly after swimming. Remember to apply suncream on and behind your ears.
- Do not let your skin burn.
- Stay out of the sun during the hottest part of the day. This is usually between 11am and 3pm.
It is important to remember there is no right or wrong way to feel. Everyone’s reactions are different and you might have a mixture of emotions.
Talking about your feelings can be helpful. If other people know how you feel, it makes it easier for them to support you. You can talk to your doctor or specialist nurse for support too. Occasionally, some people may need more than the advice and support of their healthcare professionals, family and friends.
Sometimes it is easier to talk to someone who is not directly involved in your situation. If you are finding it difficult to cope, your specialist or GP can usually refer you to a counsellor who can help. You can call the Macmillan Support Line on 0808 808 00 00 to speak to our cancer support specialists about anything that is on your mind.
We have more information if the Bowen’s disease has made you feel more self-conscious about the way you look (body image).
Below is a sample of the sources used in our skin cancer information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
Motley et al. British Association of Dermatologists. Management of the patient with primary cutaneous squamous cell carcinoma. 2009.
National Institute for Health and Care Excellence (NICE). NG12: Suspected cancer: recognition and referral. 2015 (updated 2017).
National Institute for Health and Care Excellence (NICE). NG134: Sunlight Exposure: Benefits and Risks. 2016.
National Institute for Health and Care Excellence (NICE). PH32: Skin Cancer Prevention. 2011 (updated 2016).
Scottish Intercollegiate Guidelines Network (SIGN) 140. Management of primary cutaneous squamous cell carcinoma. 2014.
Telfar N et al. Guidelines for the management of basal cell carcinoma. British Journal of Haematology. 2008.
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Professor James Larkin, Consultant Medical Oncologist.
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