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. Bowen disease most commonly is reported in whites.
Patients often present with an asymptomatic, slowly enlarging, erythematous, scaly patch or plaque.
It may occur anywhere on the mucocutaneous surface. A delay in diagnosis often is encountered because the lesion is asymptomatic, early skin changes may be subtle and overlap clinical features seen in many benign conditions. Lesions may appear on sun-exposed or covered skin. The head and neck are the most commonly affected anatomic locations, followed by the limbs. Lesions vary in size from a few millimeters to several centimeters in diameter.