Understanding Bowen’s Disease: Symptoms, Causes, and Treatments

What is Bowen’s Disease?

Bowen’s disease is a form of early skin cancer, also known as squamous cell carcinoma in situ. This means the cancerous cells are confined to the outer layer of the skin (the epidermis) and have not yet spread deeper. Although it is considered non-invasive, Bowen’s disease has the potential to develop into invasive squamous cell carcinoma if left untreated, which makes early detection and treatment crucial.

It is typically slow-growing and may be present for months or even years before being noticed. The condition often appears as a persistent red, scaly patch that may resemble other skin conditions, which can make diagnosis tricky without medical evaluation.

It’s important to distinguish Bowen’s disease from conditions like actinic keratosis, which is a precancerous lesion caused by sun damage. While actinic keratosis can also progress to skin cancer, it affects cells in a slightly different way and may present as rough, scaly areas rather than well-defined red patches. Bowen’s disease also tends to have a more clearly defined border and is usually larger and more persistent than actinic keratoses.

Signs and Symptoms of Bowen’s Disease

The most common sign of Bowen’s disease is the appearance of a persistent, red, scaly patch on the skin. These patches may be flat or slightly raised and often have well-defined edges. Unlike eczema or psoriasis, the affected area doesn't usually clear up with moisturisers or over-the-counter creams, which can be an early clue that something more serious is going on.

Some people may notice itching, tenderness, or a burning sensation, but in many cases, the lesion is painless. Over time, the patch may grow slowly and may occasionally crack or bleed, especially if it’s on a part of the body that experiences frequent movement or friction.

Where Does Bowen’s Disease Appear?

• Legs: Often found on the lower legs, particularly in older adults. On this area, it may appear as a dry, reddish-brown scaly plaque.

• Face and Neck: On sun-exposed areas like the cheeks or forehead, the lesion may be pinker and thinner, sometimes mistaken for a harmless blemish.

• Hands and Arms: May resemble sun damage but usually has a rougher texture and clearer borders.

• Genital Area or Around the Nails: Though less common, Bowen’s disease can also occur in these areas and may be mistaken for warts or fungal infections.

Because Bowen’s disease can mimic other skin conditions, early detection is key. If caught early, treatment is usually straightforward and highly effective, significantly reducing the risk of progression to invasive cancer.

What Causes Bowen’s Disease?

Several factors can contribute to the development of Bowen’s disease, with chronic sun exposure being one of the most significant. Ultraviolet (UV) radiation from the sun can damage the DNA in skin cells over time, leading to abnormal changes and, eventually, cancerous growths. This is why Bowen’s disease is often found on sun-exposed areas such as the face, neck, and lower legs.

Another well-established cause is infection with human papillomavirus (HPV), particularly types associated with genital warts. This is especially relevant when Bowen’s disease appears on the genital skin or around the nails.

In people with weakened immune systems, whether due to medical conditions like HIV or the use of immunosuppressive medications (e.g., after organ transplants), there is a higher risk of developing Bowen’s disease. A reduced immune response makes it harder for the body to identify and repair abnormal skin cells. To find out more information, get in touch with us today!

Who Is Most at Risk?

Several risk factors can increase the likelihood of developing Bowen’s disease:

• Older age: Most cases occur in people over 60.

• Fair skin: Individuals with lighter skin tones are more vulnerable to UV damage.

• History of frequent sun exposure or sunburns.

• A personal or family history of skin cancer.

• Exposure to carcinogenic chemicals, such as arsenic.

• Long-standing skin injuries or chronic inflammation.

Recognising these risk factors can help in identifying high-risk individuals who may benefit from regular skin checks and early dermatological advice.

Treatment Options for Bowen’s Disease

The good news is that Bowen’s disease is highly treatable, especially when diagnosed early. A range of effective treatment options is available, depending on the size, location, and severity of the lesion, as well as the patient’s overall health.

Topical Treatments

For smaller or superficial lesions, topical creams can be very effective. Medications such as imiquimod or 5-fluorouracil (5-FU) are applied directly to the affected area to stimulate the body’s immune system or destroy abnormal cells. These are usually prescribed for several weeks and may cause redness or irritation while the treatment works.

Cryotherapy and Photodynamic Therapy

Cryotherapy involves freezing the lesion with liquid nitrogen, destroying abnormal cells through extreme cold. It’s a quick, in-clinic procedure and suitable for small or isolated patches.

Photodynamic therapy (PDT) is another non-invasive option. This involves applying a light-sensitive cream to the area, followed by exposure to a special light that activates the treatment and targets abnormal cells. PDT is often chosen for facial lesions due to its cosmetic results.

Surgical Removal

In cases where the lesion is larger, more aggressive, or located in a high-risk area, surgical excision may be recommended. This involves removing the affected tissue and surrounding healthy margin to ensure complete clearance. Surgery is generally highly effective and may be followed by a biopsy to confirm the diagnosis.

Expert Skin Cancer Care in Newry

If you’ve noticed a persistent, unusual patch on your skin, it’s important not to delay assessment. At Newry Private Clinic, our dermatology specialists provide expert evaluation and personalised treatment for Bowen’s disease, with access to advanced therapies and same-week appointments.

Early diagnosis makes all the difference. Book your dermatology consultation in Newry today and take the first step towards peace of mind and effective care.

Bowen’s Disease vs Other Skin Conditions

Because Bowen’s disease often appears as a red, scaly patch, it can be easily mistaken for other common skin conditions. However, there are a few key differences that help distinguish it from conditions like actinic keratosis, eczema, and psoriasis.

Actinic Keratosis

Both Bowen’s disease and actinic keratosis are linked to sun exposure and may appear on similar areas of the body. However, actinic keratoses are typically smaller, rougher, and feel like sandpaper. They may be easier to overlook and often occur in clusters. In contrast, Bowen’s disease usually presents as a single, well-defined, red plaque that continues to grow over time.

Eczema

Eczema often presents with itchy, dry, and inflamed skin that may come and go in flares. It tends to affect both sides of the body symmetrically and responds well to moisturisers and topical steroids. Bowen’s disease, on the other hand, usually remains persistent and unresponsive to standard eczema treatments. It typically occurs in one area and lacks the intense itching seen in eczema.

Psoriasis

Psoriasis produces thick, silvery-white scales and often appears on the elbows, knees, or scalp. It may also involve pitting of the nails or joint pain. While Bowen’s disease can look similar, especially in its early stages, it usually lacks the silvery scaling and systemic features associated with psoriasis. Unlike psoriasis, it does not tend to follow a long-term relapsing-remitting course.

The Importance of a Proper Diagnosis

Because visual similarities can make self-diagnosis difficult, it’s essential to seek a professional assessment if you notice any persistent or unusual skin changes. A dermatologist may perform a skin biopsy to confirm the diagnosis and rule out other conditions.

At Newry Private Clinic, our dermatology team provides fast, expert diagnosis and tailored treatment plans to ensure accurate care — especially when it matters most.

Why Early Detection is Critical

While Bowen’s disease is considered non-invasive, it carries a risk of progressing to invasive squamous cell carcinoma (SCC) if left untreated. Invasive SCC can grow deeper into the skin, spread to other parts of the body, and become significantly more difficult to treat. Although this progression is relatively uncommon, it remains a serious concern — and it’s entirely preventable with early intervention.

The Role of Regular Skin Checks

Most cases of Bowen’s disease can be diagnosed and treated effectively before they become dangerous. That’s why regular skin checks are so important, particularly for individuals at higher risk — such as those with fair skin, a history of sun exposure, or a personal or family history of skin cancer.

Even if a patch seems harmless, any persistent or unusual skin change should be evaluated by a professional. Early diagnosis not only improves outcomes but also allows for less invasive treatments with minimal scarring or side effects.

At Newry Private Clinic, our dermatology specialists offer thorough skin assessments and fast access to care. If you’re concerned about a suspicious lesion or would like peace of mind, book a skin check in Newry today — because when it comes to skin cancer, early action saves lives.

Dermatology Services at Newry Private Clinic

At Newry Private Clinic, we offer a comprehensive range of dermatology services tailored to diagnosing and treating conditions like Bowen’s disease. Our team of experienced specialists is committed to providing expert, timely care in a supportive and confidential environment.

Our Dermatology Services Include:

• Skin cancer screening: Full-body skin assessments to detect early signs of Bowen’s disease, melanoma, and other skin cancers.

• Diagnostic biopsies: Performed quickly and safely in-clinic to confirm or rule out serious conditions.

• Individualised treatment plans: From topical therapies and cryotherapy to minor surgical procedures, every patient receives a treatment plan based on their unique needs.

• Follow-up care and monitoring: We ensure long-term skin health with regular reviews and post-treatment support.

If you’ve noticed a new or persistent patch of abnormal skin, or if you have a history of sun exposure or skin cancer, don’t wait. Early diagnosis leads to better outcomes — and treatment is often simpler than you might expect.

Book your dermatology consultation in Newry today and take the next step towards confident, expert skin care.