Abstract: Objective: To summarize the dermoscopic features of superficial basal cell carcinoma (BCC) and Bowen's disease, and to explore the diagnostic value of dermoscopy for differentiating between these two conditions. Methods: A retrospective analysis was conducted on patients with histopathologically confirmed superficial BCC and Bowen's disease at Peking Union Medical College Hospital between September 2021 and September 2023. Clinical presentations and dermoscopic features were collected and compared between groups. Using histopathology as the gold standard, the accuracy of clinical diagnosis by visual inspection alone and in combination with dermoscopy was calculated. Results: A total of 29 patients with superficial BCC and 64 patients with Bowen's disease meeting the inclusion and exclusion criteria were enrolled, among whom 20 superficial BCC and 23 Bowen's disease patients underwent dermoscopic examination. The mean age of patients with superficial BCC and Bowen's disease was (67.5 ± 13.3) and (69.9 ± 10.9) years, respectively, with male-to-female ratios of 1:2.22 and 1:1.13. No significant differences were observed between the two groups in terms of lesion location, single or multiple lesions, well-defined lesion borders, or the presence of ulceration/bleeding (all P > 0.05), except for the proportion of lesions <1 cm in diameter and the proportion of brown-colored lesions, which showed statistically significant differences.Common dermoscopic features of superficial BCC included shiny white blotches or strands (80%), leaf-like structures/spoke-wheel areas/concentric structures (70%), and fine short telangiectasia (60%). In contrast, common dermoscopic features of Bowen's disease included glomerular vessels (87.0%), yellow scales (78.3%), dotted vessels (69.6%), and homogeneous brown/gray pigmentation (65.2%). Compared with Bowen's disease, superficial BCC exhibited a higher proportion of shiny white blotches/strands (80.0% vs. 43.5%, P=0.015), leaf-like structures/spoke-wheel areas/concentric structures (70% vs. 0%, P < 0.001), fine short telangiectasia (60.0% vs. 26.1%, P=0.025), scattered brown dots (50.0% vs. 13.0%, P=0.008), blue-gray dots/globules (20.0% vs. 0%, P=0.024), and blue-gray ovoid nests (30.0% vs. 0%, P=0.002), while it exhibited a lower proportion of dotted vessels (15.0% vs. 69.6%, P < 0.001), glomerular vessels (10.0% vs. 87.0%, P < 0.001), homogeneous brown/gray pigmentation (15.0% vs. 65.2%, P=0.001), and yellow scales (40.0% vs. 78.3%, P=0.010).The diagnostic accuracy of clinical visual diagnosis for superficial BCC and Bowen's disease was 48.3% and 60.9%, respectively. Among cases undergoing dermoscopic examination, the accuracy of clinical visual diagnosis alone was 30.0% for superficial BCC and 43.5% for Bowen's disease, but improved to 85.0% and 78.3%, respectively, when dermoscopic features were incorporated. Conclusion: Significant differences exist between the dermoscopic features of superficial BCC and Bowen's disease. Dermoscopy enhances the diagnostic accuracy of these conditions and can serve as a valuable tool for clinical differentiation.