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Bowen’s Disease

Bowen’s disease is a precancerous form of skin cancer. It often grows slowly over time and if left untreated can develop into squamous cell skin cancer (approximately 3-5 cases in 100).

Bowen’s disease has a similar appearance to eczema or psoriasis. It usually appears as a patch on the skin and doesn’t heal. The patch may be:

  • Red or pink
  • Scaly or crusty
  • Flat or raised
  • Itchy at times
  • Up to a few centimetres in diameter

The patch can appear anywhere on the body but often appears in exposed areas such as the lower legs, neck, and head. Sometimes they can affect the groin area. Bowen’s disease is not contagious. It is more common in women and usually affects
people aged 60 and above.
The cause of Bowen’s disease is linked to:

  • Sun exposure
  • Weak immune system
  • Previous radiotherapy treatment
  • Human papillomavirus (HPV)

Bleeding, open sores or lumps can indicate that the patch has developed into a squamous cell skin cancer.

Treatments depend on the size and location but could be cryotherapy, chemotherapy cream, curettage (where the area is scraped away), photodynamic therapy (which is a cream followed by laser treatment to destroy abnormal cells), or surgery.
Referral: Patients should receive a routine referral. Only consider a suspected cancer pathway referral if there has been difficulty differentiating the lesion from a squamous cell carcinoma.


Actinic keratosis
Actinic keratosis is a type of crusty skin growth which is often caused by damage from UV light.
It looks like patches on the skin which can vary in size (from mm to cm), may be itchy and can be pink, red or brown in colour. The patches may even look like small horns or spikes.
This commonly affects sun exposed areas of the body such as the face, scalp and hands. If left untreated there is a small chance it can develop into a squamous cell carcinoma.
Patients with one incidence of actinic keratosis have a higher chance of developing more in the future.

Referral: Patients should receive a routine referral. Only consider a suspected cancer pathway referral if there has been difficulty differentiating the lesion from a squamous cell carcinoma.


Skin cancer prevention

Dr Rachel Abbott, Consultant Dermatologist, discusses the importance of speaking to patients about skin cancer prevention.

Key points:

  • An estimated 90% of skin cancers are due to sun exposure
  • It is unusual to develop moles over the age of 40 – a new growth could be seborrhoeic keratosis which is common in ageing, but new skin growths should be monitored for change
  • It can be beneficial to discuss sun safety and skin cancer prevention with any patients that come in with concerns about their moles, especially younger patients and immuno-suppressed people. They can be signposted to skin charities such as Melanoma
    UK, Skcin, Macmillan or others for further support, advice and resources.


Additional resources

Link: Bowen’s Disease, NHS (2019)
Link: Bowen’s Disease, Macmillan Cancer Support (2021)
Link: Actinic keratoses (solar keratoses), NHS (2020)
Link: Pre-cancerous skin lesions, Skcin
Link: Actinic keratoses, British Association of Dermatologists (2020)
Link: Sun safety and prevention, Skcin

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