SKIN CANCERS
Bowen’s disease
Bowen’s disease is squamous cell carcinoma in situ, a skin cancer confined to the outer layer of skin.
- Also known as intraepithelial carcinoma (IEC)
- May appear as a pink scaly patch
- Non-surgical treatment options
Because Bowen’s disease is often mistaken for a minor skin irritation, it can go unassessed for months before being correctly diagnosed.
What does Bowen’s disease look like?
Bowen’s disease usually appears as a flat red or pink scaly patch on the skin. The surface may look dry, flaky or slightly crusted.
The appearance can resemble a number of common skin conditions, including dermatitis, psoriasis or fungal infections, which is why medical assessment is often needed to confirm the diagnosis.
It most commonly occurs on areas exposed to the sun over many years, such as the face, ears, scalp, hands, forearms and lower legs.
In some cases Bowen’s disease appears as a persistent irritated patch that does not heal over many months.
MBBS, MA (Virtual Comm), Grad Cert Hlth Info, Grad Dip Comp Inf Sci
Bowen's disease/intraepithelial carcinoma/squamous cell carcinoma in situ on the arm. The appearance in this case is pink and slightly raised.
On the temple of an elderly man. Inflamed and irritated with a crusted surface.
Bowen's disease with an irregular shape and fine scale
Bowen's disease with an irregular shape and smoother surface.
Diagnosis
A persistent pink or scaly patch may be Bowen’s disease. Diagnosis is usually confirmed with a punch or shave biopsy, examined by a pathologist.
Risk and progression
Bowen’s disease is squamous cell carcinoma in situ: abnormal cells remain in the surface layer. It is more common with fair skin, long-term UV exposure or immunosuppression. HPV infection can also be associated with some lesions.
If untreated, some lesions become invasive SCC, which can cause deeper damage and occasionally spread. A growing, thickening, tender or ulcerated lesion needs reassessment.
Treatment
Options include surgical excision, fluorouracil cream, cryotherapy and photodynamic therapy. Choice depends on confirmation of the diagnosis, lesion size and location, clearance, cosmetic outcome and your preferences.
At Spot Check, fluorouracil/calcipotriol combination cream may also be used for selected Bowen’s disease. A 2026 international expert panel supports this approach, but controlled-trial success rates for the combination are not yet available. It must not be used as a substitute for assessment or treatment of invasive SCC.
A clinical review with dermoscopy is needed after non-surgical treatment to check clearance. The clinic will confirm your review date. Persistent or recurrent areas may need biopsy or further treatment.
See our comparison of non-surgical treatments for diagnosis-specific results and follow-up periods.
Reference: Loranger et al., 2026 expert panel recommendations.
After a diagnosis of Bowen's disease
People diagnosed with Bowen’s disease have an increased risk of developing additional skin cancers. Regular skin checks and sun protection are important.
Check your skin regularly for signs of skin cancer. Be alert for “ugly duckling” spots that look different from your other moles or lesions.
Due to a higher risk of skin cancers in future, including potentially serious squamous cell carcinomas, have a yearly full body skin check with an experienced skin cancer doctor.
Even if you’ve already been diagnosed with skin cancer, it’s not too late to reduce your risk. Wear sunscreen whenever the UV index is over 3, cover up with long sleeves, sunglasses and a hat, and stay in shaded areas when possible.
Treatments for Bowen’s disease
Concerned about a persistent scaly patch?
Bowen's disease is treatable when diagnosed early. A skin check or spot assessment can confirm the diagnosis and determine the most appropriate treatment.
Arrange a 1–3 spot assessment