Bowen's Disease (SCC in Situ)
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.
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