What is Bowen’s disease?
Bowen’s disease is squamous cell carcinoma in situ — meaning the abnormal cells are confined entirely to the outermost layer of the skin (the epidermis) and haven't invaded any deeper. Left untreated over years, a small proportion can progress into invasive squamous cell carcinoma, which is why treatment is recommended even though it isn't an emergency.
Causes and risk factors
- Cumulative UV exposure, similar to other keratinocyte skin cancers.
- Fair skin and older age.
- Immunosuppression.
- Human papillomavirus (HPV) infection is implicated in some cases, particularly on the lower legs.
- Past arsenic exposure — historically relevant, now rare in Australia.
Signs to look for
- A slow-growing, red, scaly, well-defined patch or plaque.
- Can resemble a persistent patch of eczema or psoriasis that doesn't respond to standard creams.
- Usually flat rather than raised, though the surface may be slightly crusted.
- Most common on the lower legs (especially in women) and other sun-exposed sites.
⚠ See a doctor if
You have a persistent scaly red patch that hasn't responded to a standard eczema or psoriasis cream after a few weeks — it's worth having it properly assessed rather than continuing to self-treat.
Diagnosis
Dermoscopy helps narrow the diagnosis, but a biopsy is usually needed to confirm Bowen’s disease and distinguish it from other scaly patches such as actinic keratosis, psoriasis, or eczema.
Treatment options
Cryotherapy
Suitable for smaller, well-defined patches.
Photodynamic therapy (PDT)
Particularly useful for larger patches or those in cosmetically sensitive areas.
Curettage & cautery, or excision
Surgical removal for thicker or higher-risk lesions.
Topical treatment
Prescription topical creams may suit select superficial cases.
Prevention
- Sun protection — SPF 30+ daily, protective clothing, and shade.
- Regular skin checks, particularly on the lower legs and other frequently exposed areas.
- Prompt review of any scaly patch that isn't improving with standard treatment.
Frequently asked questions
Is Bowen's disease the same as skin cancer?
Yes — it's an early, non-invasive form of squamous cell carcinoma. Because it's confined to the surface layer of skin, it's much simpler to treat than invasive SCC, which is exactly why catching it at this stage matters.
Can Bowen's disease be mistaken for eczema or psoriasis?
Yes, that's common — it can look very similar to a patch of dermatitis or psoriasis. A patch that isn't responding to standard treatment after a few weeks is a reasonable prompt for a proper assessment.
How long does treatment take to heal?
This depends on the treatment used and the size of the patch — cryotherapy sites typically heal over one to two weeks, while PDT or surgical treatment may take a little longer. Your doctor will talk you through what to expect for your specific treatment.