Bowen’s Disease: When Should We Refer?
Potential pitfall
Bowen's disease is an intra-epidermal squamous cell carcinoma (SCC) of the skin, otherwise known as a squamous cell carcinoma in situ. Left untreated, Bowen's disease may progress to invasive SCC; this may occur in as many as 16.3% of people with Bowen’s disease.
Helpful hint
If there are features suggestive of progression to invasive SCC, then patients should be referred to secondary care via an urgent suspected cancer pathway. Concerning features include:
- Rapid growth
- Pain or tenderness
- Bleeding
- Ulceration or induration
- Surrounding inflammation
- An elevated, raised, or thickened lesion
- Lesions on the lips, genitals, perianal area or around the nails/digits
Be cautious in immunosuppressed patients, in particular post-transplant patients, who are at high risk of developing SCC that tend to metastasise quicker. Remember age (it usually affects patients in their 60s and 70s).
Seek advice and guidance if there is any diagnostic uncertainty.
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