Home

Search

Pathway AI

Account ⋅ Sign Out

Table of contents

Bowen disease

Definition
Bowen disease, also known as SCC in situ, is a precancerous skin condition characterized by the presence of atypical squamous cells.
1
Pathophysiology
The exact pathophysiology of Bowen disease is not fully understood, but chronic UV radiation exposure, certain genetic mutations, and HPV play a role in the abnormal and uncontrolled growth of squamous cells.
1
Epidemiology
The incidence of Bowen disease in Canada is estimated at 28 per 100,000 in males and 22 per 100,000 in females. The incidence of Bowen disease in the Netherlands is estimated at 8.1 per 100,000 person-years.
2
3
Disease course
Clinically, Bowen disease presents as persistent, scaly, red, or pink patches on the skin that may resemble other skin conditions such as psoriasis or eczema.
1
Prognosis and risk of recurrence
The prognosis of Bowen disease is generally good, as most cases do not progress to invasive SCC. However, due to the risk of progression, diligent monitoring and treatment are necessary.
1
Key sources
The following summarized guidelines for the evaluation and management of bowen disease are prepared by our editorial team based on guidelines from the British Association of Dermatologists (BAD 2023), the German Society of Dermatology (DDG/DKG/DeCOG 2023), the U.S. Preventive Services Task Force (USPSTF 2023; 2018), the American Society of Plastic Surgeons (ASPS 2021), the European Dermatology Forum (EDF 2019), and the British Photodermatology Group (BPG/BAD 2019).
1
2
3
4
5
6
7
8
9
10
11

Guidelines

1.Screening and diagnosis

Indications for screening: as per USPSTF 2023 guidelines, insufficient evidence to assess the balance of benefits and harms of visual skin examination by a clinician to screen for skin cancer in adolescents and adults.
I
Create free account

2.Diagnostic procedures

Biopsy: as per BAD 2023 guidelines, consider performing a punch biopsy or diagnostic excision when clinical and dermoscopic features are not sufficient for diagnosis of SCC in situ.
C

More topics in this section

  • Curettage

3.Medical management

Conservative management: consider offering conservative measures, including moisturizers (preferably urea-based) and skin surveillance, in patients with poor health and multiple SCC in situ lesions, especially on the lower legs, where there is a greater risk of long-term ulceration after treatment. Perform a biopsy if SCC is suspected.
E

More topics in this section

  • Topical 5-FU

  • Topical imiquimod

  • Topical tazarotene

4.Therapeutic procedures

Photodynamic therapy: as per BAD 2023 guidelines, offer conventional, red-light photodynamic therapy as a treatment option in patients with SCC in situ, particularly for poorly healing or cosmetically sensitive skin sites, multiple lesions, and large lesions.
A
Show 2 more

More topics in this section

  • Cryotherapy

  • Curettage with cautery

  • Laser therapy

  • Radiotherapy

5.Surgical interventions

Standard surgical excision: as per BAD 2023 guidelines, perform standard surgical excision in patients with SCC in situ if there is diagnostic uncertainty regarding an invasive disease.
A
Show 3 more

More topics in this section

  • Mohs micrographic surgery

6.Patient education

General counseling: provide educational material or a patient information leaflet on SCC in situ and for any proposed treatment modality.
E

7.Preventative measures

Sun protection
Counsel persons with fair skin types aged 6 months to 24 years and parents of young children about minimizing exposure to UV radiation to reduce the risk of skin cancer.
B
Offer counseling selectively in adults > 24 years with fair skin types about minimizing exposure to UV radiation to reduce the risk of skin cancer, taking into consideration the presence of risk factors for skin cancer.
B

8.Follow-up and surveillance

Skin reconstruction after tumor resection, timing: consider performing reconstructive surgery in a delayed (asynchronous) fashion in adult patients after skin cancer resection.
C

More topics in this section

  • Skin reconstruction after tumor resection (perioperative antibiotics)

  • Skin reconstruction after tumor resection (perioperative antithrombotics)

  • Skin reconstruction after tumor resection (perioperative analgesics)

  • Skin reconstruction after tumor resection (follow-up)

  • Follow-up