Medicines for Bowen's disease

What it is

Bowen's disease is a very early form of skin cancer that affects only the surface layer of the skin. It is sometimes described as 'squamous cell carcinoma in situ', meaning that abnormal (cancerous) cells are present but are confined to the top layer of the skin and have not spread deeper or elsewhere. Because of this, it is a very early and highly treatable condition with an excellent outlook, and is not the same as an invasive skin cancer. Bowen's disease is most common in older people, particularly those with fair skin, and is usually related to long-term sun exposure (though other factors can contribute). It typically appears as a persistent red or pinkish, scaly or crusty patch of skin, which is usually flat or slightly raised, and grows slowly over time; it is often found on sun-exposed areas such as the lower legs (common in women), the head and neck, or elsewhere. It can look similar to other common skin conditions (such as eczema, psoriasis, or a patch of dry skin), which is why a persistent patch that does not clear up should be checked, so it can be diagnosed correctly. Bowen's disease is usually harmless in the sense that it is confined to the surface, but it is important because, if left untreated, a small proportion of cases can, over time, progress into an invasive squamous cell carcinoma (skin cancer that grows deeper) — so it is treated or monitored. The good news is that Bowen's disease is easily treatable with a range of effective treatments, and, being caught at such an early stage, the outlook is excellent. The key messages are that Bowen's disease is a very early, surface form of skin cancer appearing as a persistent red, scaly patch, that it is easily treatable with an excellent outlook, and that a persistent patch that does not clear up should be checked.

How it is treated

Bowen's disease is easily treatable with a range of effective options, and, because it is caught at a very early stage, has an excellent outlook; the key is having a persistent skin patch assessed and diagnosed. A persistent red, scaly patch that does not clear up (particularly on sun-exposed skin) should be checked by a GP or dermatologist, who can assess it and, where needed, confirm the diagnosis with a biopsy (as it can resemble other skin conditions). Once diagnosed, treatment depends on the size, number, and location of the patches and the individual, and effective options include: creams applied to the skin (which treat the affected area over a period); freezing (cryotherapy); curettage (scraping and cauterising the area); photodynamic therapy; and, in some cases, minor surgery to remove the area; some lesions, particularly small or slow-growing ones in certain situations, may be monitored. The choice is discussed with the doctor, and treatment is usually straightforward and effective. Because Bowen's disease is related to sun damage and indicates sun-damaged skin (with a higher risk of other skin cancers), ongoing sun protection is worthwhile, and people who have had it may be advised on skin awareness and monitoring for further lesions. It is important to be alert to changes: if a patch of Bowen's disease becomes lumpy, thickened, tender, painful, grows, bleeds, or turns into a non-healing sore or ulcer, it should be checked promptly, as this could indicate progression to an invasive skin cancer. The reassuring messages are that Bowen's disease is a very early, surface form of skin cancer that is easily treatable with several effective options and has an excellent outlook, that treating it prevents the small risk of progression to invasive cancer, and that a persistent patch that does not clear up should be checked — so getting it assessed and treated, along with sun protection and skin awareness, are the key steps.