Bowen Disease

Updated: Nov 07, 2019
  • Author: Mary V Kaldas, MD; Chief Editor: Dirk M Elston, MD  more...
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First described by the American dermatologist John T. Bowen in 1912, Bowen disease is a squamous cell carcinoma (SCC) in situ with the potential for significant lateral spread. [1] Larger lesions can reach several centimeters in diameter.

The image below depicts Bowen disease of the right temple.

Bowen disease right temple. Bowen disease right temple.

See Nonmelanoma Skin Cancers You Need to Know, a Critical Images slideshow, to help correctly identify these lesions.



Bowen disease is a form of intraepidermal carcinoma, a malignant tumor of keratinocytes. Bowen disease may ultimately progress to an invasive squamous cell carcinoma.



Bowen disease may arise de novo or from a preexisting actinic keratosis. The etiology is most likely multifactorial.Note the following:

  • Chronic UV radiation exposure: The age and sun-exposed body distribution of Bowen disease suggests the importance of chronic sun damage as a factor in the carcinogenesis of Bowen disease. [2]

  • Arsenic exposure: The literature supports an association between Bowen disease and arsenic exposure, often occurring after a time lag of 10 years. The main sources of arsenic exposure include Fowler solution, a medication formerly used to treat psoriasis; Gay solution, a medication formerly used to treat asthma; contaminated well water; and certain pesticides. [3, 4]

  • Human papillomavirus: Human papillomavirus type 16 is by far the most common subtype isolated from lesions of Bowen disease, although other subtypes, such as HPV 2, 18, 31, 33, 54, 56, 61, 62, and 73 also have been found. [5, 6, 7, 8]

  • Immunosuppression: Immunosuppressed patients with Bowen disease are more likely to have multiple tumors and more aggressive tumors. [9]

Other possible causes include genetic factors, trauma, other chemical carcinogens, and x-ray radiation.



US frequency

Because no national health databases collect the numbers of nonmelanoma skin cancers and because of regional differences in incidence rates, estimating the frequency of Bowen disease is difficult. In 1991, a study from Minnesota reported the annual average rate of Bowen disease as 14.9 cases per 100,000 whites. [10] In 1994, a study from Hawaii reported a rate 10 times that, 142 cases per 100,000 whites. [11]


Bowen disease is most commonly reported in sun-exposed sites of whites. Bowen disease rarely occurs in patients with darker-pigmented skin; if it does, it usually affects nonexposed sites. [12]


The ratio of Bowen disease is approximately equal between males and females. Bowen disease is more commonly found on the head and neck of men and on the lower limbs and cheeks of women. [2]


Bowen disease occurs in adulthood, with the highest incidence in patients older than 60 years. [13]



The prognosis for Bowen disease is favorable. The majority of studies report a risk of progression to invasive SCC at 3-5%. According to a retrospective case series with multiple potential biases, of those that become invasive SCC, one third may metastasize. The risk of invasive carcinoma is estimated to be higher for genital Bowen disease or erythroplasia of Queyrat at 10%. [14]

Much controversy surrounds whether Bowen disease is associated with internal malignancies. [15, 16, 17, 18, 19] Many early papers reported such an association in 15-70% of cases. Some later reports supported an association of internal malignancies with Bowen disease that was associated with arsenic ingestion but not with Bowen disease from other causes. [3] In 1989, a meta-analysis of 12 studies showed no significant association. The most recent population-based cohort study of 1147 Bowen disease patients in Denmark demonstrated no statistically significant increased risk of internal cancers. Currently, Bowen disease is not believed to be a paraneoplastic condition. [19]


Patient Education

Patients with a history of Bowen disease should be counseled on safe sun behavior, to include avoiding the sun when it is most intense (between 10 am and 4 pm), wearing hats and other sun protective clothing, and using a dual-spectrum sunscreen with an SPF of 30 or higher.

For patient education resources, visit the Cancer Center and First Aid and Injuries Center. Also, see the patient education articles Skin Cancer, Skin Biopsy, and Sunburn.