Bowen’s Disease in Grand Rapids, Michigan

Bowen’s disease is an early form of skin cancer (squamous cell carcinoma in situ) where abnormal cells are confined to the epidermis, the uppermost layer of the skin. When these cancer cells grow deeper into the dermis, the condition is then called invasive squamous cell carcinoma, which can rarely spread (metastasize) to other parts of the body and become life‑threatening.

In Grand Rapids and across West Michigan, Bowen’s disease is most often seen by dermatologists at major health systems such as Corewell Health (formerly Spectrum Health), Trinity Health Grand Rapids, Metro Health – University of Michigan Health, and Mercy Health.

What Is Bowen’s Disease?

Bowen’s disease can appear on any part of the body, but the lower legs are most commonly affected. Because it often looks like other red, scaly skin conditions (such as psoriasis or eczema), it can be easily mistaken for a benign rash.

Key Characteristics

  • A form of non‑melanoma skin cancer
  • Cancer cells limited to the epidermis (in situ)
  • Can very slowly progress over time
  • Has the potential to become invasive squamous cell carcinoma if untreated

Who Gets Bowen’s Disease in Grand Rapids?

Fair Skin and Sun Exposure Are Major Risk Factors

In Michigan, many residents have lighter skin tones and spend time outdoors in all seasons—summer at Lake Michigan beaches, fall hiking, and winter sports. Fair skin combined with UV exposure is the main risk factor for Bowen’s disease.

Risk patterns seen in Grand Rapids are similar to national trends:

  • More common in women than men
  • Most cases occur in people over age 40
  • Higher risk in those with a history of frequent sunburns, tanning bed use, or long‑term outdoor work (construction, landscaping, farming, road work)

The Kent County Health Department and local dermatology clinics in Grand Rapids regularly stress sun protection due to the strong summer sun and reflective UV from snow in winter.

Signs and Symptoms of Bowen’s Disease

The Condition Isn’t Contagious and Treatment Is Usually Successful

Bowen’s disease is not contagious and cannot be spread from person to person. With early diagnosis and appropriate treatment from a dermatologist in Grand Rapids, outcomes are typically excellent.

Common Signs of Bowen’s Disease

Typical features include:

  • Flat or slightly raised red patch
  • Scaly or crusty surface
  • Well‑defined, irregular edges that stand out from surrounding skin
  • Patch that persists for months to years and does not fully clear with moisturizers or over‑the‑counter creams
  • May be single or multiple patches

Each Patch Grows Very Slowly

Bowen’s disease usually:

  • Grows gradually over months to years
  • Is often asymptomatic (no pain, no itch)
  • Is commonly found on lower legs, but can occur on:
    • Arms and hands
    • Face, ears, and scalp (especially in people with thinning hair)
    • Trunk
    • Genital area

When Bowen’s Disease Becomes Concerning

Only rarely are the patches sore or irritated. However, if a patch of Bowen’s disease:

  • Becomes thicker or more raised
  • Feels tender or painful
  • Starts bleeding, crusting, or ulcerating

…it may be changing into invasive squamous cell carcinoma and needs immediate medical attention. In Grand Rapids, this usually means calling your primary care provider or a dermatologist at one of the local health systems for an urgent skin evaluation.

Risk Factors for Bowen’s Disease

The exact cause of Bowen’s disease is often unknown, but several well‑established risk factors increase the likelihood of developing it.

Gender

  • More common in women than men
  • Elderly women are particularly prone, especially on the lower legs

Age

  • Most patients are over 40
  • Risk increases with cumulative sun exposure over many years

Sun Exposure

Bowen’s disease is more common in sunny or high‑UV environments, but it also occurs frequently in Michigan due to:

  • Intermittent intense sun exposure in summer (boating, camping, beaches)
  • UV reflection from snow and ice in winter
  • Outdoor work or hobbies without consistent sunscreen or protective clothing

Common high‑risk areas:

  • Lower legs
  • Face and ears
  • Backs of hands and forearms
  • Bald or thinning scalp

Arsenic Exposure

  • Long‑term exposure to arsenic (historically in some well water or certain industrial settings) increases risk.
  • Grand Rapids residents who have lived in older homes with private wells or worked in specific manufacturing industries should discuss any concerns with their doctor.

Systemic Immunosuppression

People with weakened immune systems are at higher risk, including:

  • Organ transplant recipients taking long‑term immunosuppressive medications
  • People on chronic high‑dose steroids or other immune‑suppressing therapies
  • Individuals with certain immune system disorders

These patients are often followed closely by specialists at Corewell Health, Trinity Health Grand Rapids, or Metro Health and should have regular skin checks.

Viral Infection (HPV)

Certain types of human papillomavirus (HPV) can predispose to Bowen’s disease, especially in the genital area. This is more likely when:

  • There is a history of high‑risk HPV infection
  • The immune system is weakened

How Bowen’s Disease Is Diagnosed in Grand Rapids

Bowen’s disease is often easily overlooked, especially because it may not itch or hurt. Many cases in Grand Rapids are picked up during routine skin cancer screenings at local dermatology practices.

Diagnostic Steps

A Grand Rapids dermatologist or primary care provider will typically:

  1. Take a thorough medical history

    • Duration of the lesion
    • History of sun exposure, tanning beds, or sunburns
    • Occupational and environmental exposures (e.g., arsenic)
    • Immune system status and medications

  2. Perform a full skin examination

    • Check the suspicious patch and the rest of the skin
    • Look for additional lesions or signs of sun damage

  3. Biopsy of the lesion

    • A small sample of the abnormal skin is removed under local anesthetic
    • The tissue is sent to a laboratory for pathology examination
    • Confirms whether it is Bowen’s disease and rules out invasive cancer

Biopsies are routinely performed in dermatology clinics across Grand Rapids, and results typically return within several days.

Treatment Options for Bowen’s Disease

Treatment is almost always successful, especially when started early. Your dermatologist in Grand Rapids will recommend a treatment based on:

  • Size and location of the lesion
  • Number of lesions
  • Your age and overall health
  • Immune status
  • Cosmetic concerns and scarring risk

Common treatments include:

Cryosurgery (Cryotherapy)

  • The lesion is frozen with liquid nitrogen
  • Causes the abnormal cells to die and peel off
  • Often done in a single office visit
  • May cause temporary blistering, redness, or light/dark spots

Curettage (With or Without Cautery)

  • The lesion is scraped off with a special instrument (curette)
  • The base of the wound may be treated with cauterization (lightly burned with an electric current) to destroy remaining cells and control bleeding
  • Typically performed under local anesthetic in the office
  • Has a high success rate (around 90% when performed by experienced dermatologists)

Photodynamic Therapy (PDT)

  • A light‑sensitizing cream is applied to the lesion
  • After a set time, a special light is used to activate the cream and destroy abnormal cells
  • Often used for larger areas or multiple lesions
  • Success rates are generally 60–80% with specialists
  • Available at selected dermatology and cancer centers in Grand Rapids

Topical Creams

Medications applied directly to the lesion can include:

  • 5‑fluorouracil (5‑FU) cream
  • Imiquimod cream

These creams:

  • Are used over several weeks
  • Work by either killing abnormal cells or stimulating the immune system to attack them
  • Have success rates similar to PDT
  • Can cause temporary redness, crusting, or irritation at the treatment site

Surgical Excision

  • The lesion is surgically cut out with a margin of normal skin
  • The wound is then sutured closed
  • Has a near 100% success rate when margins are clear
  • Leaves a surgical scar, which is an important consideration on visible areas like the face

This is often preferred when:

  • Invasive squamous cell carcinoma is suspected
  • The lesion is thick or recurrent
  • A definitive one‑time treatment is desired

Radiation Therapy

  • Now rarely used for Bowen’s disease
  • May be considered for:
    • Patients who cannot undergo surgery
    • Lesions in difficult‑to‑treat areas
  • Delivered by radiation oncology teams at major Grand Rapids hospitals

Living in Grand Rapids: Local Considerations for Skin Health

In West Michigan, certain environmental and lifestyle factors affect skin cancer risk:

  • Cold winters: People may underestimate UV exposure due to cloud cover and cold temperatures, but UV rays still penetrate clouds and reflect off snow.
  • Lake Michigan recreation: Boating, fishing, and beach days increase sun exposure, especially with reflection from water and sand.
  • Outdoor work and sports: Construction, farming, landscaping, running, golfing, and cycling all increase cumulative UV exposure.

To reduce your risk of Bowen’s disease and other skin cancers in Grand Rapids:

  • Use broad‑spectrum sunscreen (SPF 30 or higher) year‑round
  • Wear protective clothing, hats, and UV‑blocking sunglasses
  • Avoid tanning beds
  • Seek shade during peak sun hours (10 a.m. – 4 p.m.)
  • Perform monthly self‑skin checks
  • Schedule regular skin exams with a dermatologist, especially if you have risk factors

Where to Get Help for Bowen’s Disease in Grand Rapids, MI

If you notice a persistent red, scaly patch that does not heal, especially on your lower legs, arms, or face, contact a healthcare provider for evaluation.

Local options include:

  • Your primary care provider (GP/family doctor)

    • Can perform an initial assessment and refer you to a dermatologist

  • Dermatologists in Grand Rapids

    • Corewell Health (Spectrum Health) dermatology clinics
    • Trinity Health Grand Rapids dermatology services
    • Metro Health – University of Michigan Health dermatology
    • Independent dermatology practices throughout Kent County

  • Public Health Resources

    • Kent County Health Department and Grand Rapids Public Health can provide information on skin cancer prevention, community screenings, and local clinics.

Key Points About Bowen’s Disease

  • Bowen’s disease can occur on any part of the body, but the lower legs are most commonly affected.
  • Fair skin and sun exposure are the main risk factors, especially relevant for Grand Rapids residents who spend time outdoors in all seasons.
  • The condition is not contagious, and treatment is usually very successful when diagnosed early.
  • Bowen’s disease is often asymptomatic and can be easily overlooked; regular skin checks are important.
  • If a long‑standing red, scaly patch becomes raised, painful, or starts bleeding, seek prompt medical care to rule out invasive squamous cell carcinoma.

Early evaluation by a Grand Rapids dermatologist or primary care provider is the best way to ensure accurate diagnosis and effective treatment.