Research suggests penile Bowen disease is linked to human papillomavirus (HPV). While penile Bowen disease is considered precancerous, the skin lesions generally don’t turn into cancer.

The skin in your genital area is sensitive. Aggravation from everyday irritants like sweat, friction, or shaving is common.

Skin changes, no matter how small, aren’t something to be ignored. Even painless marks might be an indication of a skin disorder or early symptoms of a more serious condition.

Penile Bowen disease, for example, may not cause you any discomfort at first, but if left untreated, it’s a disease that can progress into penile cancer.

Penile Bowen disease is the presentation of Bowen disease on the hair-bearing skin areas of your penis.

It’s one of three primary forms of penile intraepithelial neoplasia, otherwise known as precancerous skin lesions on your penis.

Bowen disease

Bowen disease is a rare skin disease affecting your epidermis, the outermost layer of your skin. It was originally described medically in 1912 by a physician named J. T. Bowen.

The exact causes of Bowen disease are unknown. It’s typically found on areas of your skin exposed to the sun and on your lower legs — though it’s able to affect any area of your body, including your penis.

Bowen disease isn’t painful and doesn’t always have symptoms beyond visual skin changes. You may not notice one of these lesions right away — they’re sometimes only a few millimeters in size and may be hidden amongst hair in your genital area.

Penile Bowen disease is characterized by the appearance of a slow-growing lesion on the hair-bearing skin of male genitals, including the shaft of your penis or your scrotum.

Bowen lesions can vary in size, shape, texture, and color. They can be a few millimeters to a few centimeters in diameter.

Possible presentations of penile Bowen disease are similar to those of Bowen disease in other areas of your body.

You may notice a flat or slightly raised patch of skin that looks:

  • reddish brown or pink
  • pale/hypopigmented
  • vascular/dotted with small blood vessels
  • peppered with brown-gray spots or globules
  • dry/crusty or scaly

Itchiness and tenderness are possible, with some people experiencing:

  • oozing pus from infection
  • bleeding
  • a warty texture
  • splits or fissures in the lesion
  • dark coloring/hyperpigmentation

Bowen disease involves a single patch of skin in most people, but approximately 10–20% of people have multiple lesions in more than one location.

Receiving a diagnosis of penile Bowen disease doesn’t mean you have cancer.

Penile Bowen disease belongs to a group of conditions classified as “precancerous,” a term indicating the presence of abnormal, cancer-like cell growth that doesn yet meet the criteria of cancer.

Less than 10% of Bowen lesions progress into skin cancer.

Because of this cancer link, though, penile Bowen disease is often clinically considered the earliest, noninvasive (not tending to spread) form of squamous cell carcinoma.

It may be referred to as “squamous cell carcinoma in situ,” which means the cancer cells are localized (have not spread), noninvasive, and only present in the top layer of your skin.

Squamous cell carcinoma is one of the most common forms of skin cancer. It develops in the squamous cells on the outer part of your epidermis. Approximately 95% of penile cancers start in the squamous cells.

The exact causes of Bowen disease aren’t clear. In its classic presentation on areas of your body outside of your genitals, it’s thought to be related to:

  • prolonged sun exposure
  • advanced age
  • arsenic exposure
  • use of immune-suppressing medications

Penile Bowen disease may have a unique cause. Research suggests Bowen disease on genitalia is linked to human papillomavirus (HPV) infection.

HPV strains 16, 18, 34, and 48 have all been linked to genital-specific Bowen disease, with HPV 16 being the most common culprit. HPV 16, a strain identified as “high risk” for cancer, is also the potential cause of cervical, vulvar, and anal cancers, as well as certain types of mouth and throat cancers.

HPV is so common that almost all sexually active people are expected to contract the virus at some point in life.

Bowen lesions are slow-growing, taking months or even years to change.

They’re not considered life threatening for the majority of people and may never cause symptoms or progress into invasive forms of cancer.

When penile Bowen lesions do progress, you may notice changes such as:

  • increased size
  • coloration changes
  • worsening irritation, bleeding, or discharge

If penile Bowen disease progresses into invasive squamous cell carcinoma, it can cause:

  • swelling in other areas of your genitals
  • inflamed lymph nodes/lumps in your groin
  • discharge from your penis
  • pain/difficulty urinating

Bowen disease exists in the topmost layer of your skin, making it highly treatable, even in locations like your penis.

A doctor will decide on your treatment regime based on your overall health, the locations and size of the Bowen lesions, and any symptoms you’re experiencing.

Not everyone decides to treat Bowen disease right away. A doctor may regularly monitor your lesion for changes, holding off on treatments until signs of disease progression appear.

Because of the intimate location of penile Bowen disease, it’s natural to want to pursue treatment sooner rather than later.

Your options include:

Radiotherapy is used less often in Bowen disease treatment compared with other methods, but no single therapy appears to be superior to the others.

In a 2023 meta-analysis, photodynamic therapy was found to have less long-term success (more lesions recurred after 24-60 months) compared with surgery. Photodynamic therapy, however, was rated higher than surgery or cryotherapy when it came to cosmetic appearance post-treatment.

No traditional surgical options were included in the review. Overall, the authors indicated the literature on Bowen treatments was too low quality to make a recommendation on a preferred treatment method.

A more recent Cochrane review of treatment options hasn’t been conducted.

Penile Bowen disease is a precancerous skin condition occurring on the hair-producing skin areas of male genitals. It’s a presentation of Bowen disease, a type of skin lesion that can appear anywhere on your body.

Unlike classic forms of Bowen disease, penile Bowen disease is thought to be related to HPV infections, though this may not be the only cause.

Topical treatments and procedures that remove Bowen lesions are highly successful.