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).
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).
If SCC is suspected then refer using the Skin - USC (2WW) pathway.
If referral is indicated and SCC/malignancy is not suspected then patients can be referred via eRS to:
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:
References
(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
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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