Merck Manual

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Bowen Disease

(Bowen's Disease; Intraepidermal Squamous Cell Carcinoma)


Gregory L. Wells

, MD,

  • Assistant Professor of Dermatology
  • Idaho College of Osteopathic Medicine
  • Lab Director and Partner
  • Ada West Dermatology and Dermatopathology

Last full review/revision May 2019| Content last modified May 2019
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Bowen disease is an early form of squamous cell carcinoma that is confined to the outer layer of the skin (epidermis) and has not yet invaded the deeper layers.

Bowen disease most commonly occurs on sun-exposed areas of the skin but may occur anywhere.

There may be many carcinomas or only a few. The affected skin is red-brown and scaly or crusted and flat, sometimes looking like a patch of psoriasis, dermatitis, or a fungal infection (called tinea or ringworm).

A biopsy is the standard procedure for confirming the diagnosis of Bowen disease. During this procedure, doctors remove a piece of the tumor and examine it under a microscope.

Doctors may remove the cancer in the office by scraping and burning it with an electric needle (a procedure called curettage and electrodesiccation) or by cutting it out. Doctors may destroy the cancer by using extreme cold (cryosurgery), electrocautery, or by applying a chemotherapy drug to the skin).

Because squamous cell carcinomas seem to be related to UV exposure, doctors recommend a number of measures to limit UV exposure, starting in early childhood:

  • Avoiding the sun: For example, seeking shade, minimizing outdoor activities between 10 AM and 4 PM (when the sun’s rays are strongest), and avoiding sunbathing and the use of tanning beds

  • Wearing protective clothing: For example, long-sleeved shirts, pants, and broad-brimmed hats

  • Using sunscreen: At least sun protection factor (SPF) 30 with UVA and UVB protection used as directed and reapplied every 2 hours and after swimming or sweating but not used to prolong sun exposure

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