Clinical spectrum of Bowen’s disease in pigmented skin: report of five cases from Colombo South Teaching Hospital, Sri Lanka

Bowen’s Disease (BD), also termed squamous cell carcinoma in situ, is a non-invasive intraepidermal malignancy characterized by solitary or multiple, slowly enlarging erythematous, scaly papules or plaques. Lesions typically exhibit well-demarcated margins, although border irregularity may be present. We report a case series of five adult patients diagnosed with Bowen’s disease, each demonstrating diverse pigmentary and morphological variations. This heterogeneity in clinical presentation underscores the diagnostic complexity of the condition. The lesions exhibited variable morphologies – including differences in color, texture, and border definition – and were distributed across multiple anatomical regions. 
Continued reporting of such atypical and varied manifestations is critical to improving diagnostic accuracy and clinician awareness, particularly in regions where Bowen’s disease is frequently underrecognized or misdiagnosed.