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Bowen's Disease

Checked: 23-08-2020 by Vicky Ryan Next Review: 23-08-2021

Overview

Local dermatologists recommend the Bowen's Disease clinical guidance (1) provided by the Primary Care Dermatology Society.

There as also guidelines available on the BAD (2) and DermNet (3) websites.

Bowen's disease is an intra-epidermal (in situ) squamous cell carcinoma of the skin. The rate of transformation to invasive squamous cell carcinoma (SCC) is approximately 3% (1).

Who to Refer

Bowen's disease can often be diagnosed and managed in primary care - see the guidelines on management PCDS (1,2).

If there is diagnostic uncertainty then consider requesting Dermatology Advice & Guidance.

Alternatively an excision/biopsy in primary care (if available) can confirm the diagnosis.

If there is concern that the lesion is malignant then refer via the USC pathway (see red flags below).

Red Flags

If SCC is suspected then refer using the Skin - USC (2WW) pathway.

Referral

If referral is indicated and SCC/malignancy is not suspected then patients can be referred via eRS to:

Dermatology advice and guidance (tick box allowing conversion to referral if required)
Dermatology (secondary care) or,
Community Dermatology Service

Please attach photos including dermoscopy images if possible.

Funding Policy

Referral to secondary care for assessment and treatment of Bowen's Disease is no longer subject to the Benign Skin Lesions Policy. but the policy does state the following:

For lesions where there is diagnostic uncertainty - please use dermatology advice and guidance service initially.
Pre-malignant lesions (e.g. Actinic keratosis, Bowens disease) should usually be managed in primary care with support of advice and guidance if necessary. Referral should only be made following advice or treatment failure.

Resources

References

(1) Bowen's Disease (PCDS)

(2) Bowen's Disease (British Association of Dermatologists)

(3) Intraepidermal squamous cell carcinoma, intraepidermal SCC, Bowen's disease (DermNet)

Prescribing

Refer to the BNSSG Formulary for the latest prescribing guidance.

Patient Leaflets

Bowen's Disease - PCDS
Bowen's Disease - British Association of Dermatologists

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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