Bowen's Disease
Also known as: SCC in Situ
Early-stage SCC confined to the top skin layer. A persistent, well-defined red scaly patch - 3-5% progress to invasive cancer.
What to look for
Side-by-side comparison
Normal skin
No persistent red patches
Bowen's disease
Well-defined red scaly patch
Bowen's disease is squamous cell carcinoma in situ - malignant cells present but not yet invaded beyond the epidermis. It represents the stage between actinic keratosis and invasive SCC.
It presents as a slowly enlarging, well-defined, red or pink scaly patch with sharp irregular borders. Unlike eczema, it is typically a single persistent patch rather than multiple lesions.
Without treatment, approximately 3-5% progress to invasive SCC. A key diagnostic clue is a single, well-defined scaly patch that does not respond to steroid creams or antifungals.
Quick self-check
Does this look like bowen's disease? Answer 2 questions.
Is it a single, well-defined scaly patch (not multiple)?
Has it persisted despite treatment attempts?
Risk factors
- Chronic sun exposure
- Fair skin
- Age over 60
- Immunosuppression
- Arsenic exposure
- HPV infection (genital form)
When to see a dermatologist
- ⚠A persistent red scaly patch not responding to eczema or fungal treatments
- ⚠A single slowly growing patch on the lower leg or sun-exposed area
- ⚠Any scaly patch present for months without healing
Often confused with
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Full ABCDE check →Frequently asked questions
Is Bowen's disease cancer?
Technically yes - SCC in situ. But the cancer cells are confined to the epidermis and cannot spread. It is the earliest, most treatable stage. Without treatment, 3-5% progress to invasive SCC.
Can it be mistaken for eczema?
Very commonly. Key differences: Bowen's is usually a single well-defined patch; eczema tends to be multiple. Bowen's does not respond to steroid creams; eczema typically improves. Persistent single patches failing standard treatment should be biopsied.
Sources
Based on clinical guidelines from the American Academy of Dermatology (AAD) and British Association of Dermatologists (BAD). Statistics from NCI SEER Program and IARC GLOBOCAN. Staging per AJCC Cancer Staging Manual, 8th ed. Full methodology