Larger lesions can reach several centimeters in diameter.
Much controversy exists as to whether Bowen disease is associated with internal malignancies. 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. Both chronic solar damage and inorganic arsenic ingestion have been implicated as etiologic factors in the development of Bowen disease. Genetics, trauma, other chemical carcinogens, and radiation also may play a role. Quite often, no etiologic factor is determined.