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Bowens Disease

 

Introduction

Bowen’s disease is an area of UV-damaged skin, which if left untreated can very occasionally turn into squamous cell carcinoma, the rate of transformation is approximately 3%1. 

 

In Scope          

  • Bowen Disease

 

Not in Scope           

  • Squamous Cell Carcinoma, other dermatology conditions

 

Red Flags

  • Ulceration of the lesion
  • Tender Lesion
  • Surrounding Inflammation
  • Fast growing lesion
  • Elevated lesion +- induration
  • Bleeding

*This list is not exhaustive

 

Primary Care Management

Straightforward Bowen’s disease can be managed in primary care.


A punch biopsy is not usually necessary but can be useful if there is a poor response to treatment/diagnostic uncertainty.  If squamous cell carcinoma is suspected, refer on fast track cancer pathway without a biopsy.

 

First line:

  • ®5-FU cream Warn the patient to expect some redness, crusting and mild discomfort. After four weeks stop the treatment and consider using a mild topical steroid eg 1% Hydrocortisone or Eumovate® cream BD for two weeks to help settle down any inflammation. The maximum area you can treat with 5-FU is 500cm2 (23 x 23cm). It is safe to treat several areas of Bowen's up to this max area.
     
  • Cryotherapy
     
  • Educate patient on Sunscreen and sun safety - NHS

 

Follow Up:

  • Patients should be followed up at three months
     
  • The presence of any remaining rough scale would suggest that the lesion has not fully responded to treatment and that more is required, whereas the presence of smooth skin, sometimes with associated post-inflammatory hyperpigmentation (especially on the lower legs), suggests that the lesion has responded well, in which case further follow-up is not required.

 

Advice and guidance

Available via e-RS

 

Referral Information

Fast Track Dermatology Referral

If there are any red flags causing suspicion of a Squamous Cell Carcinoma, please refer on the fast-track cancer pathway to dermatology.

 

Routine Dermatology Referral

  • Bowen Disease not responding to Primary Care treatment. Refer to consider photodynamic therapy
  • Diagnostic uncertainty (unless malignancy in the differential – then refer on fast track cancer pathway)
  • Large lesions (more than 10cm in diameter)

 

Useful Information

Professional Information

 

Patient’s Information

 

References

  • Bowen's disease(PCDS Bowen’s Disease Page)
  • Morton CA, Birnie AJ, Eedy DJ. British Association of Dermatologists’ guidelines for the management of squamous cell carcinoma in situ (Bowen’s disease). British Journal of Dermatology. 2014;170: 245-260.

 

Page Review Information

Date Reviewed                  30 March 2026

Date Review next due        30 March 2028

GP Sifter                           Dr Kate Northridge

Contributors                      Dr Alexander Anderson, Consultant Dermatologist Royal Cornwall Hospital