What is Bowen’s Disease?

Bowen’s disease, also known as squamous cell carcinoma in situ (SCC in situ), is a form of skin cancer. The term “in situ” tells us that this is a surface form of skin cancer. Bowen’s Disease was first described by Dr. John T. Bowen in 1912 and thus bears his name.

Bowen’s is usually a red, scaly patch. It tends to be seen on areas frequently exposed to the sun such as the face, arms and legs. Some itch, crust or ooze, but most have no particular feeling. SCC in situ may be mistaken for rashes, eczema, fungus or psoriasis. Sometimes they are brown and look like a benign keratosis or a melanoma. Because of this, a biopsy must usually be done to confirm the diagnosis.

Causes of Bowen’s include sun damage, exposure to arsenic, immuno-suppression (cancer drugs, drugs for certain types of psoriasis, arthritis, Crohn’s disease, HIV), certain viral infections, and chronic skin injuries. Bowen’s disease rarely occurs before the age of thirty and most commonly occurs in individuals over the age of sixty. Interestingly, women outnumber men in this diagnosis, with 70-85% of the diagnosis occurring in women. Of these between 60-85% occur on the lower leg.

The simplest and most common treatment for SCC in situ is surgical excision. Other options of treatment include curettage and electrodessication (ED&C) which is essentially a burning and scraping of the skin cancer, as well as the use of photodynamic therapy (PDT). PDT is an alternative way to treat SCC in situ using a drug that is absorbed preferably by cancer cells. A bright light is then applied causing the release of toxins and destruction of the tumor.

Advanced Dermatology specializes in PDT. PDT is a preferable option because it can leave less scarring. However, it is not approved by the FDA in the US (it is widely used in some European countries for this condition). We can discuss treatment options for you if you are diagnosed with this condition.

If you have had an SCC in situ, you have a higher risk of other skin cancers. Untreated, SCC in situ grows larger over time and may spread out to be several inches. 5% of SCC in situ will eventually develop into invasive squamous cell carcinoma if not treated.  Prevention is always the best way to “treat” diseases! Don’t forget to apply sunscreen to your lower legs, front AND back as well as schedule annual body checks.