Can Bowen's disease become invasive cancer?

Yes. Without treatment, approximately 3-5% of Bowen's disease cases progress to invasive squamous cell carcinoma that can spread beyond the skin. This is why treatment is recommended even though Bowen's disease itself is confined to the top layer of the skin.

How is Bowen's disease treated?

Treatment options include topical medications (5-fluorouracil or imiquimod), cryotherapy, photodynamic therapy (PDT), surgical excision, and Mohs surgery. The choice depends on the size, location, and whether the lesion has recurred after previous treatment.

Is Bowen's disease the same as SCC?

Bowen's disease is SCC in situ, meaning the cancerous cells are confined to the epidermis and have not invaded deeper layers. It is an early stage of SCC. Once the cells break through to the dermis, it becomes invasive SCC, which carries a risk of spreading.

Conditions We Treat

Bowen's Disease (SCC in Situ)

Bowen's Disease is an early form of squamous cell carcinoma found only in the upper layer of the skin. It appears as a reddish or brown patch and is sometimes confused with eczema or psoriasis. Accurate diagnosis is made through biopsy. Treatment may include creams, cryotherapy, or excision, depending on size and location.

Bowen's disease, also known as SCC in situ, is an early form of squamous cell carcinoma in which the cancerous cells are confined to the epidermis (the outermost layer of the skin) and have not yet invaded deeper layers. The condition typically presents as a reddish, scaly patch with well-defined borders. Without treatment, approximately 3-5% of cases may progress to invasive squamous cell carcinoma. Bowen's disease is more common in older adults, in sun-exposed areas, and its incidence in Israel is elevated due to intense UV exposure.

Symptoms

Reddish or pinkish patch with well-defined borders
Scaly or crusted surface that does not respond to moisturizing creams
The lesion is usually flat or slightly raised
May cause mild itching but is usually painless
Grows slowly over months to years

Treatment Options

Mohs micrographic surgery for recurrent or cosmetically sensitive cases
Standard surgical excision
Topical medications (5-fluorouracil, imiquimod)
Photodynamic therapy (PDT)
Cryotherapy for small lesions

Why Mohs Surgery?

Mohs surgery is particularly recommended for Bowen's disease when the lesion is in a cosmetically sensitive area, when it is recurrent after previous treatment, or when the lesion is large. Real-time margin control ensures complete removal and prevents progression to invasive SCC.

Learn about Mohs Surgery

Frequently Asked Questions

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This medical content was reviewed and verified by Dr. Yehonatan Kaplan on April 8, 2026