Bowen’s diseaseBMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m813 (Published 20 March 2020) Cite this as: BMJ 2020;368:m813
- Padma Mohandas, specialist registrar dermatology1,
- Martyn Lowden, general practitioner2,
- Sandeep Varma, consultant dermatologist and honorary (consultant) assistant professor1 3
- 1Nottingham NHS Treatment Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- 2Cropwell Bishop Health Centre, Cropwell Bishop, Nottingham
- 3School of Medicine, University of Nottingham, Nottingham
- Correspondence to: P Mohandas
What you need to know
Bowen’s disease is a slow growing, precancerous dermatosis and a precursor to squamous cell carcinoma
Multiple therapeutic options mean management can be individualised depending on the number, size, and site of lesions
Prognosis is excellent with high cure rates
A 68 year old woman with skin type 1 presents with an 18 month history of a well circumscribed 10 mm erythematous scaly patch over her left shin. Since retirement, she has lived in Spain for part of the year and has now returned to the UK, worried that the patch has increased in size.
In Bowen’s disease the full thickness of the epidermis is dysplastic with atypical keratinocytes, but these have not yet breached the basement membrane to become a squamous cell carcinoma. Reflecting this, Bowen’s disease is also commonly known as squamous cell carcinoma in situ and as intraepidermal or intraepithelial carcinoma. Historically, progression of Bowen’s disease to squamous cell carcinoma was believed to be 3-5%.1 However, a 2017 study suggested that it may be much higher, with 16.3% of 566 cases of biopsy-proven Bowen’s disease found to have squamous cell carcinoma when treated surgically.2
This article outlines the assessment and management of Bowen’s disease in a primary care setting. Rarer variants of Bowen’s disease may present as pigmented plaques, nail dystrophy or discolouration, or patches and plaques in the genitalia, but this article focuses on the common presentation likely to be seen in primary care.
How this article was made
We conducted a literature review of articles and guidelines, reviewed dermatology textbooks, and sought expert advice from general practitioners and consultant dermatologists regarding Bowen’s disease.
What you should cover
The classic presentation of Bowen’s disease is of an asymptomatic, well circumscribed, solitary, erythematous patch or plaque on a sun-exposed site (typically head, neck, or limb), usually 10-15 mm in diameter that has been slowly growing (fig 1 …