Bowens Disease

 

Useful link:

http://www.pcds.org.uk/clinical-guidance/bowens-disease

 

Straightforward Bowen’s disease should be managed in primary care¹. A punch biopsy is not usually necessary but can be useful if there is a poor response to treatment/diagnostic uncertainty.  A 2ww referral is required if there are any concerns about SCC

 

 

FIRST-LINE TREATMENT:

• Efudix ® cream (5-FU cream) OD 4/52. Hands should be washed thoroughly after application. The treated area must be left uncovered and the cream washed off approximately 8 hours after application. 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
• Cryotherapy

* Review at 3/12 – if ongoing rough skin then needs further treatment (can consider curettage and cautery for recurrent localised areas). If skin smooth no further treatment required (there may still be post inflammatory hyperpigmentation)

 

 

POORLY HEALING AREAS:

Caution with lower legs as may develop ulceration (higher risk with cryotherapy).

• Can use Efudix cautiously: e.g OD for 3/52 then break before restarting treatment again.
• Or can observe in patients with reduced life expectancy.

 

 

LEAFLETS:

• Bowen’s disease - https://www.bad.org.uk/shared/get-file.ashx?id=235&itemtype=document
• 5FU cream: https://www.bad.org.uk/shared/get-file.ashx?id=187&itemtype=document
• Imiquimod cream: https://www.bad.org.uk/shared/get-file.ashx?id=209&itemtype=document

 

 

REFERENCES:

1. 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 ofDermatology. 2014;170: 245-260.

 

Review date                 March 2022

Next review due           March 2023

Reviewing GP              Dr Madeleine Attridge