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Bowen’s Disease – Information for GPs

Definition

Bowen’s disease is an intra-epidermal Squamous Cell Carcinoma (SCC) of the skin.

Incidence 15 per 100,000 (UK), Mean age 60-70; Female : Male= 3:1

Exclude Red Flag Symptoms

  • Squamous Cell Carcinoma
  • Bowen’s can progress to SCC in 3-5% of cases

General points

Clinical features

  • Slow-growing, erythematous scaly pink skin plaques that cause few, if any, symptoms
  • No improvement with topical steroid – a useful diagnostic test
  • Lesions usually solitary and, in general, have a diameter of less than 5cm at diagnosis
  • Most lesions occur on sun-exposed areas (e.g. head and neck and lower leg)
  • Not unusually there are associated sun exposure related lesions such as BCC, SCC, actinic keratosis

Differential diagnosis of red scaly leg lesions

  • Eczema – often itchy, possibly discoid eczema
  • Psoriasis – ask about FH, scale more marked when flicked
  • Tinea – central clearing, itchy
  • Superficial spreading BCC – look very carefully for a pearly, raised edge - stretch lesion and look from side
  • Granuloma annulare – raised but smooth, usually annular, often skin coloured or pale pink

Management

  • Encourage smoking cessation
  • Encourage weight loss (if appropriate)
  • Thorough skin examination for associated sun-exposure lesions

Treatment

  • Fluorouracil 5% cream (Efudix®)
    Bd for 2-4 weeks, provide patient information leaflet here
    It often causes a quite severe inflammatory reaction, which is a normal part of the treatment, and patients need to be warned of this.
    If inflammation is brisk and severe – treatment may have been adequate so stop
    Soothing emollients can be used
    Review 6 weeks after end of treatment
  • Imiquimoid (Aldara®)
    Before prescribing please check the Formulary list to understand the commissioning position – available here. Advice from BAD on Imiquimoid here

Investigations prior to referral

Refer if diagnostic doubt or lack of response to Rx

Information to include in referral letter

  • Indication for referral
  • Previous treatments tried and their effect
  • Photograph of lesion
  • Any histology results
  • Relevant past medical/surgical history
  • Current regular medication
  • BMI and smoking status

Patient information

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