Ep 89 – Bowen’s disease

Bowen's disease, also known as squamous cell carcinoma in situ, is a type of skin disorder characterised by the presence of precancerous or intra-epidermal squamous cell carcinoma. It was named after John T. Bowen, the dermatologist who first described the condition in 1912. Bowen's disease primarily affects the outermost layer of the skin (epidermis) and is considered a form of non-invasive skin cancer. Bowen's disease most commonly occurs on sun-exposed areas of the skin, such as the face, neck, head, hands and forearms. However, it can also occur in areas not exposed to the sun. In this episode, Dr Roger Henderson looks at how best to diagnose and manage Bowen’s disease, as well as looking at its prognosis and prevention.

Key references

1. Primary Care Dermatology Society. Bowen’s disease. Accessed 22 January 2024.
2. Morton CA, et al. Br J Dermatol. 2014;170(2):245-60. doi: 10.1111/bjd.12766.
3. DermNet. Intraepidermal squamous cell carcinoma. May 2023.
4. Bath-Hextall FJ, et al.Cochrane Database Syst Rev. 2013;2013(6):CD007281. doi: 10.1002/14651858.CD007281.pub2.

Key take-home points

• Bowen's disease is characterised by abnormal growth and maturation of squamous cells in the epidermis, with these cells undergoing dysplastic changes.
• Clinically, Bowen's disease often presents as well-defined, scaly, reddish-brown patches or plaques on the skin. These lesions may resemble eczema or psoriasis, making diagnosis challenging without proper evaluation.
• Bowen's disease most commonly occurs on sun-exposed areas of the skin, such as the face, neck, head, hands and forearms. However, it can also occur in areas not exposed to the sun.
• Prolonged exposure to ultraviolet radiation from the sun is a significant risk factor for developing Bowen's disease. Other risk factors include age, fair skin and a history of chronic sun exposure.
• In some cases, Bowen's disease may be associated with infection by certain types of human papillomavirus (HPV). However, the role of HPV in Bowen's disease is not fully understood.
• While Bowen's disease itself is considered non-invasive, if left untreated, it may occasionally progress to invasive squamous cell carcinoma. Therefore, early detection and appropriate management are crucial.
• Diagnosis is typically confirmed through a skin biopsy, although this may not always be necessary depending upon clinical appearance and the diagnostic confidence of the clinician involved.
• Treatment options include topical therapies, cryotherapy and surgical excision. The choice of treatment depends on factors such as the size and location of the lesions.
• With proper treatment, the prognosis for Bowen's disease is generally good.