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Skin Cancer Bowen’s Disease Appearance

Bowen’s disease lesions are slightly elevated, red, scaly plaques with surface fissures and foci of pigmentation. The borders are well defined, and lesions closely resemble psoriasis, chronic eczema, actinic keratosis, superficial basal cell carcinoma, seborrheic keratosis, and malignant melanoma. Lesions tend to be stable over many months to years. Pruritus and inflammation are usually absent. They are found most often on the lower limbs of women and on the scalp and ears of men.

The plaque grows very slowly by lateral extension and may eventually, after several months or years, invade the dermis, producing induration and ulceration. When confined to the epidermis the atypical cells, in contrast to actinic keratosis, involve epidermal appendages, particularly the hair follicle.

In contrast to actinic keratosis the basal cells are normal. Atypical cells are also found at the periphery of lesions in clinically uninvolved skin. Atypical cells in the epidermal lining of the hair follicle, although still confined to the epidermis, are deeper and much more difficult to reach by treatment modalities such as topical 5-FU or electrosurgery.