Materiały źródłowe

• #1 Interventions for cutaneous Bowen’s disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6464151/

  Bowen’s disease is the clinical term for in situ squamous cell carcinoma of the skin. Cutaneous lesions present as largely asymptomatic, well-defined, scaly erythematous patches on sun-exposed skin. In general, people with Bowen’s disease have an excellent prognosis because the disease is typically slow-growing and responds favourably to treatment. Lesions are persistent and can be progressive, with a small potential (estimated to be 3%) to develop into invasive squamous cell carcinoma. The relative effectiveness of the available treatments is not known for Bowen’s disease, and this review attempts to address which is the most effective intervention, with the least side effects, for cutaneous Bowen’s disease. […] We included 9 studies, with a total of 363 participants. One study demonstrated statistically significantly greater clearance of lesions of Bowen’s disease with MALPDT (methyl aminolevulinate with photodynamic therapy) when compared with placeboPDT (RR (risk ratio) 1.68, 95% CI (confidence interval) 1.12 to 2.52; n = 148) or cryotherapy (RR 1.17, 95% CI 1.01 to 1.37; n = 215), but there was no significant difference when MALPDT was compared to 5FU (5-fluorouracil). One study demonstrated statistically significantly greater clearance of lesions with ALAPDT (5-aminolevulinic acid with photodynamic therapy) versus 5FU (RR 1.83, 95% CI 1.10 to 3.06; n = 66), but no statistically significant difference in recurrence rates at 12 months (RR 0.33, 95% CI 0.07 to 1.53).

• #2 Non-surgical management of actinic keratosis, Bowen’s disease and non-melanoma skin cancer | The PMFA Journal

  https://www.thepmfajournal.com/features/post/non-surgical-management-of-actinic-keratosis-bowen-s-disease-and-non-melanoma-skin-cancer

  Bowens disease (BD) is histologically characterised as SCC in situ. Clinically it tends to present as a discrete, scaly, erythematous patch or plaque, often affecting the lower legs in women and on the scalp and ears in men. Lesions may be confused with psoriasis or eczema. […] Several aetiological factors of BD have been described; ultraviolet (UV) radiation, radiotherapy, arsenic ingestion, immunosuppression and human papillomavirus infection are associated with increased risks of developing BD. Development of a lump or ulcer, pain or bleeding within BD may indicate progression to SCC, which occurs in about 3-5% of cases. […] Surgical management remains the mainstay of treatment of BCC and SCC, with Mohs micrographic surgery often regarded as the gold standard of treatment for the former. However, in cases where tissue sparing or non-surgical treatment modalities are preferred, or in low-risk tumours, topical or non-invasive treatment options can sometimes be used. A range of different non-surgical treatment options exist for the treatment of AK, BD and some cases of NMSC; new agents continue to be developed and added to the list of choices available.

• #3 Bowen’s disease

  https://www.nhs.uk/conditions/bowens-disease/

  Bowen’s disease usually appears as a patch on the skin that has clear edges and does not heal. […] It’s important to get a proper diagnosis, as Bowen’s disease can look like other conditions, such as psoriasis or eczema. […] There are a number of treatment options for Bowen’s disease. Talk to your dermatologist about which treatment is most suitable for you. […] After having treatment for Bowen’s disease, you may need follow-up appointments with your dermatologist or GP to see if you need any further treatment. […] See a GP if an existing patch starts to bleed, change in appearance or develops a lump do not wait for your follow-up appointment. […] Make sure you protect your skin from the sun wear protective clothing and use a sunscreen with a high sun protection factor (SPF) of at least 30.

• #4 Ep 89 – Bowen’s disease

  https://gpnotebook.com/podcasts/dermatology/ep-89-bowens-disease

  Bowen’s disease is characterised by abnormal growth and maturation of squamous cells in the epidermis, with these cells undergoing dysplastic changes. […] Clinically, Bowen’s disease often presents as well-defined, scaly, reddish-brown patches or plaques on the skin. These lesions may resemble eczema or psoriasis, making diagnosis challenging without proper evaluation. […] While Bowen’s disease itself is considered non-invasive, if left untreated, it may occasionally progress to invasive squamous cell carcinoma. Therefore, early detection and appropriate management are crucial. […] Diagnosis is typically confirmed through a skin biopsy, although this may not always be necessary depending upon clinical appearance and the diagnostic confidence of the clinician involved. […] Treatment options include topical therapies, cryotherapy and surgical excision. The choice of treatment depends on factors such as the size and location of the lesions. […] With proper treatment, the prognosis for Bowen’s disease is generally good.

• #5 Practice Nursing – Managing Bowen’s disease in primary care settings

  https://www.practicenursing.com/content/clinical/managing-bowens-disease-in-primary-care-settings/

  Bowen’s disease is a rare condition, considered a precursor to squamous cell carcinoma. […] This article has hoped to give an overview of risk factors, signs and symptoms, treatment, and complications with the aim of giving nurses and non-medical prescribers increased confidence in recognising this disease. […] It is hoped that the information provided will give nurses and non-medical prescribers more confidence in recognising this disease with the aim of getting patients an earlier diagnosis, reducing the risk of complications, and improving quality of life.

• #6 Bowen’s disease

  https://www.nhs.uk/conditions/bowens-disease/

  Bowen’s disease usually appears as a patch on the skin that has clear edges and does not heal. […] It’s important to get a proper diagnosis, as Bowen’s disease can look like other conditions, such as psoriasis or eczema. […] There are a number of treatment options for Bowen’s disease. Talk to your dermatologist about which treatment is most suitable for you. […] After having treatment for Bowen’s disease, you may need follow-up appointments with your dermatologist or GP to see if you need any further treatment. […] See a GP if an existing patch starts to bleed, change in appearance or develops a lump do not wait for your follow-up appointment. […] Make sure you protect your skin from the sun wear protective clothing and use a sunscreen with a high sun protection factor (SPF) of at least 30.

• #7 Bowen’s disease – Dermatologist

  https://www.dermatologist.org.uk/skin-conditions/bowens-disease/

  This disease then becomes an invasive skin cancer. But in both cases it requires early detection and treatment. […] Your GP will make a diagnosis based on a physical examination. He or she will then refer you to a dermatologist for a further assessment and treatment. […] The earlier this is treated the greater the results. Treatments include: […] Treatment is determined by the size and number of lesions and the extent of the condition. […] You will also be advised to cover up when out in the sun and to use a sun cream with a high sun protection factor (SPF). […] This is important. There is a risk of this disease developing into the invasive squamous cell carcinoma so monitor the condition of your skin at regular intervals.

• #8 Bowen’s Disease Treatment Reading – Causes, Symptoms & Treatments | Derma

  https://www.dermareading.co.uk/bowens-disease

  Bowen’s disease typically presents as a patch on the skin that has clear edges, and does not heal. […] It is vital that patients worried about a lesion visit their GPs, who are often able to diagnose pre-cancerous lesions. The GP may refer the patient to a dermatologist for treatment which may include a biopsy – if they feel it is appropriate. […] Patients can assist in managing their Bowens disease by self-monitoring their skin for any changes, undergoing annual follow-up appointments, and being vigilant against lifestyle factors that increase risk. […] Treatment of Bowens Disease at Derma […] There are a number of treatment options for Bowen’s disease, and the dermatologist will help you identify which are suitable, and which option is best for you. […] Some patients lesions can be treated with cryotherapy, in which liquid nitrogen is sprayed onto the affected area. Photodynamic therapy, also known as PDT uses a light source to destroy the abnormal cells.

• #9 Ep 89 – Bowen’s disease

  https://gpnotebook.com/podcasts/dermatology/ep-89-bowens-disease

  Bowen’s disease is characterised by abnormal growth and maturation of squamous cells in the epidermis, with these cells undergoing dysplastic changes. […] Clinically, Bowen’s disease often presents as well-defined, scaly, reddish-brown patches or plaques on the skin. These lesions may resemble eczema or psoriasis, making diagnosis challenging without proper evaluation. […] While Bowen’s disease itself is considered non-invasive, if left untreated, it may occasionally progress to invasive squamous cell carcinoma. Therefore, early detection and appropriate management are crucial. […] Diagnosis is typically confirmed through a skin biopsy, although this may not always be necessary depending upon clinical appearance and the diagnostic confidence of the clinician involved. […] Treatment options include topical therapies, cryotherapy and surgical excision. The choice of treatment depends on factors such as the size and location of the lesions. […] With proper treatment, the prognosis for Bowen’s disease is generally good.

• #10

  https://rms.cornwall.nhs.uk/primary_care_clinical_referral_criteria/rms/primary_care_clinical_referral_criteria/dermatology/bowens_disease

  Straightforward Bowens disease should be managed in primary care. A punch biopsy is not usually necessary but can be useful if there is a poor response to treatment/diagnostic uncertainty. A 2ww referral is required if there are any concerns about SCC […] FIRST-LINE TREATMENT: Efudix cream (5-FU cream) OD 4/52. Hands should be washed thoroughly after application. The treated area must be left uncovered and the cream washed off approximately 8 hours after application. Warn the patient to expect some redness, crusting and mild discomfort. After four weeks stop the treatment and consider using a mild topical steroid eg 1% Hydrocortisone or Eumovate cream BD for two weeks to help settle down any inflammation […] POORLY HEALING AREAS: Caution with lower legs as may develop ulceration (higher risk with cryotherapy). Can use Efudix cautiously: e.g OD for 3/52 then break before restarting treatment again. Or can observe in patients with reduced life expectancy.

• #11 Bowen's disease

  https://www.pcds.org.uk/clinical-guidance/bowens-disease

  Bowen disease is characterised by full thickness epidermal dysplasia and disordered differentiation with loss of epithelial polarity. The intraepidermal portion of cutaneous adnexae is generally affected. Parakeratosis and acanthosis are usually present and keratinocytes show variable pleomorphism, nuclear hyperchromasia and nuclear enlargement. […] Examine for other relevant skin lesions. Provide a patient information leaflet on Bowen’s disease. Direct patients to the section of this website on self-examination and also UV protection. […] A single freeze-thaw cycle with cryosurgery for 20-30 seconds – avoid in the gaiter area of the leg and other areas of poor skin healing. For larger patches treatment may be better tolerated if half of the lesion is treated initially and the other half six weeks later.

• #12 Bowen Disease Treatment & Management: Medical Care, Surgical Care, Prevention

  https://emedicine.medscape.com/article/1100113-treatment

  For specific guidelines and recommendations, please see British Association of Dermatologists guidelines for the management of people with squamous cell carcinoma in situ (Bowens disease) 2022. […] Each treatment modality has advantages and disadvantages. Choosing the best therapeutic option involves an analysis of various factors such as lesional size, number, site, degree of functional impairment, modality availability, and cost. […] Because most treatments have a recurrence risk, follow-up at 6-12 months is recommended to evaluate for recurrence. […] Factors that dictate a shorter follow-up period include history of past recurrence, presence of multiple lesions, lesions in high-risk locations, and immunosuppression. […] 5-Fluorouracil is a topical antineoplastic agent that interferes with DNA synthesis via inhibition of thymidylate synthetase and subsequently cell proliferation.

• #13 Bowen’s disease

  https://www.pcds.org.uk/patient-info-leaflets/bowens-disease

  It is important to ask a healthcare professional for a full skin examination to check for other skin lesions that may also need attention. […] In terms of treatment, this depends on various factors including size site (where the Bowens disease is located), and your general health. […] Treatment options include: Efudix cream (5-FU cream) applied thinly once a day to the affected area and up to 4 mm of normal surrounding skin, usually for 4 weeks; occasionally your doctor may recommend longer. […] Cryosurgery this is the same cold spray (liquid nitrogen) used to treat warts. […] Photodynamic therapy this involves the combination of a cream with a special light source. […] Skin surgery given the usual good response to non-surgical treatments, the main indications for surgery are if the diagnosis is uncertain and/or the lesion is not responding to treatment. […] It is important that you discuss treatment options with your specialist (or GP) and ask about anything that you do not understand.

• #14 Bowen Disease Treatment & Management: Medical Care, Surgical Care, Prevention

  https://emedicine.medscape.com/article/1100113-treatment

  It is used clinically as a 5% cream once or twice daily for a variable period, ranging from 1 week to 3 months. […] The main advantage is easy self-application by patients. […] The main adverse effect is irritation with erosions and ulcerations that may last several weeks. […] A disadvantage is that it may not be able to penetrate deep enough to treat any deep follicular extension of the tumor cells. […] Imiquimod 5% cream, a topical immune response modifier, applied 3-7 d/wk, appears to possibly be a successful treatment option for Bowen disease. […] Topical treatment for perianal Bowen disease may minimize the risk of scarring, poor wound healing, and functional impairment. […] Consider x-ray or grenz-ray radiation therapy for poor surgical candidates or patients with multiple lesions.

• #15 Bowen Disease Treatment & Management: Medical Care, Surgical Care, Prevention

  https://emedicine.medscape.com/article/1100113-treatment

  It is used clinically as a 5% cream once or twice daily for a variable period, ranging from 1 week to 3 months. […] The main advantage is easy self-application by patients. […] The main adverse effect is irritation with erosions and ulcerations that may last several weeks. […] A disadvantage is that it may not be able to penetrate deep enough to treat any deep follicular extension of the tumor cells. […] Imiquimod 5% cream, a topical immune response modifier, applied 3-7 d/wk, appears to possibly be a successful treatment option for Bowen disease. […] Topical treatment for perianal Bowen disease may minimize the risk of scarring, poor wound healing, and functional impairment. […] Consider x-ray or grenz-ray radiation therapy for poor surgical candidates or patients with multiple lesions.

• #16 Bowen's disease

  https://www.pcds.org.uk/clinical-guidance/bowens-disease

  Efudix cream (5-FU cream) OD for four weeks. Hands should be washed thoroughly after application. The treated area must be left uncovered and the cream washed off approximately 8 hours after application. Warn the patient to expect some redness, crusting and mild discomfort. After four weeks stop the treatment and consider using a mild topical steroid eg 1% Hydrocortisone or Eumovate cream BD for two weeks to help settle down any inflammation. […] Although the risk of leg ulceration is greater with cryosurgery, it can also happen with Efudix cream, as such a watch and wait policy can be offered for lesions on the gaiter area of the legs in patients with a reduced life expectancy. […] Patients should be followed up at three months. The presence of any remaining rough scale would suggest that the lesion has not fully responded to treatment and that more is required, whereas the presence of smooth skin, sometimes with associated post-inflammatory hyperpigmentation (especially on the lower legs), suggests that the lesion has responded well, in which case further follow-up is not required.

• #17

  https://rms.cornwall.nhs.uk/primary_care_clinical_referral_criteria/rms/primary_care_clinical_referral_criteria/dermatology/bowens_disease

  Straightforward Bowens disease should be managed in primary care. A punch biopsy is not usually necessary but can be useful if there is a poor response to treatment/diagnostic uncertainty. A 2ww referral is required if there are any concerns about SCC […] FIRST-LINE TREATMENT: Efudix cream (5-FU cream) OD 4/52. Hands should be washed thoroughly after application. The treated area must be left uncovered and the cream washed off approximately 8 hours after application. Warn the patient to expect some redness, crusting and mild discomfort. After four weeks stop the treatment and consider using a mild topical steroid eg 1% Hydrocortisone or Eumovate cream BD for two weeks to help settle down any inflammation […] POORLY HEALING AREAS: Caution with lower legs as may develop ulceration (higher risk with cryotherapy). Can use Efudix cautiously: e.g OD for 3/52 then break before restarting treatment again. Or can observe in patients with reduced life expectancy.

• #18 Bowen Disease Treatment & Management: Medical Care, Surgical Care, Prevention

  https://emedicine.medscape.com/article/1100113-treatment

  It is used clinically as a 5% cream once or twice daily for a variable period, ranging from 1 week to 3 months. […] The main advantage is easy self-application by patients. […] The main adverse effect is irritation with erosions and ulcerations that may last several weeks. […] A disadvantage is that it may not be able to penetrate deep enough to treat any deep follicular extension of the tumor cells. […] Imiquimod 5% cream, a topical immune response modifier, applied 3-7 d/wk, appears to possibly be a successful treatment option for Bowen disease. […] Topical treatment for perianal Bowen disease may minimize the risk of scarring, poor wound healing, and functional impairment. […] Consider x-ray or grenz-ray radiation therapy for poor surgical candidates or patients with multiple lesions.

• #19 Bowen’s disease – British Skin Foundation

  https://knowyourskin.britishskinfoundation.org.uk/condition/bowens-disease/

  Several treatments are available for Bowen disease: […] Freezing the area with liquid nitrogen (cryotherapy). This is carried out in the clinic. It can sometimes be painful, and can cause redness, puffiness, blistering or crusting, and may be slow to heal. […] This involves scraping off the abnormal skin under a local anaesthetic. The area then heals with a scab, like a graze. […] This is a cream that may control or completely remove SCC in situ. There are different ways of using it, and your doctor will explain to you how to best use it. […] This cream was originally developed for the treatment of genital warts but has been found useful in treating SCC in situ. […] Depending on the size and location of the lesion, the abnormal skin may be cut out under local anaesthetic. […] A cream is applied to the skin which makes the cells in the patch of SCC in situ sensitive to particular wavelengths of light.

• #20 Spot Check | Bowen’s disease (squamous cell carcinoma in situ)

  https://spotcheck.clinic/conditions/skin-cancers/bowens/

  Creams and serums are vital for skin health, sun damage repair, and maintaining the benefits of aesthetic procedures. […] Excision or excision biopsy is a procedure where a doctor cuts around a skin lesion through the full thickness of skin, usually closing the resulting hole with stitches. […] Photodynamic therapy uses light to activate an immune response in the skin. It is an effective treatment for people with multiple solar keratoses or skin cancers where surgery is not appropriate and a good cosmetic outcome is required.

• #21 Bowen’s disease – British Skin Foundation

  https://knowyourskin.britishskinfoundation.org.uk/condition/bowens-disease/

  Several treatments are available for Bowen disease: […] Freezing the area with liquid nitrogen (cryotherapy). This is carried out in the clinic. It can sometimes be painful, and can cause redness, puffiness, blistering or crusting, and may be slow to heal. […] This involves scraping off the abnormal skin under a local anaesthetic. The area then heals with a scab, like a graze. […] This is a cream that may control or completely remove SCC in situ. There are different ways of using it, and your doctor will explain to you how to best use it. […] This cream was originally developed for the treatment of genital warts but has been found useful in treating SCC in situ. […] Depending on the size and location of the lesion, the abnormal skin may be cut out under local anaesthetic. […] A cream is applied to the skin which makes the cells in the patch of SCC in situ sensitive to particular wavelengths of light.

• #22 Bowen Disease Treatment & Management: Medical Care, Surgical Care, Prevention

  https://emedicine.medscape.com/article/1100113-treatment

  Photodynamic therapy (PDT) has also been used, with variable success, for the treatment of Bowen disease. […] Surgical Care […] Simple excision with conventional margins […] This surgery is the most common and preferred treatment for smaller lesions and those not in problematic areas, such as the face and digits. […] For perianal Bowen disease, excision with wide margin is recommended. […] Although lesions are typically well demarcated, the actual extent of the disease may be well beyond the clinical margins. […] Mohs micrographic surgery is an excellent method for larger lesions, poorly demarcated lesions, recurrent lesions on the head and neck, or areas where tissue sparing is vital, such as digital or genital lesions. […] It offers the highest cure rate of all treatment modalities, and, because relatively thin layers are taken only in areas of proven tumor, it is a tissue-sparing procedure.

• #23 Bowen Disease Treatment & Management: Medical Care, Surgical Care, Prevention

  https://emedicine.medscape.com/article/1100113-treatment

  Photodynamic therapy (PDT) has also been used, with variable success, for the treatment of Bowen disease. […] Surgical Care […] Simple excision with conventional margins […] This surgery is the most common and preferred treatment for smaller lesions and those not in problematic areas, such as the face and digits. […] For perianal Bowen disease, excision with wide margin is recommended. […] Although lesions are typically well demarcated, the actual extent of the disease may be well beyond the clinical margins. […] Mohs micrographic surgery is an excellent method for larger lesions, poorly demarcated lesions, recurrent lesions on the head and neck, or areas where tissue sparing is vital, such as digital or genital lesions. […] It offers the highest cure rate of all treatment modalities, and, because relatively thin layers are taken only in areas of proven tumor, it is a tissue-sparing procedure.

• #24 Bowen Disease Treatment & Management: Medical Care, Surgical Care, Prevention

  https://emedicine.medscape.com/article/1100113-treatment

  Photodynamic therapy (PDT) has also been used, with variable success, for the treatment of Bowen disease. […] Surgical Care […] Simple excision with conventional margins […] This surgery is the most common and preferred treatment for smaller lesions and those not in problematic areas, such as the face and digits. […] For perianal Bowen disease, excision with wide margin is recommended. […] Although lesions are typically well demarcated, the actual extent of the disease may be well beyond the clinical margins. […] Mohs micrographic surgery is an excellent method for larger lesions, poorly demarcated lesions, recurrent lesions on the head and neck, or areas where tissue sparing is vital, such as digital or genital lesions. […] It offers the highest cure rate of all treatment modalities, and, because relatively thin layers are taken only in areas of proven tumor, it is a tissue-sparing procedure.

• #25 Bowen Disease Treatment & Management: Medical Care, Surgical Care, Prevention

  https://emedicine.medscape.com/article/1100113-treatment

  Photodynamic therapy (PDT) has also been used, with variable success, for the treatment of Bowen disease. […] Surgical Care […] Simple excision with conventional margins […] This surgery is the most common and preferred treatment for smaller lesions and those not in problematic areas, such as the face and digits. […] For perianal Bowen disease, excision with wide margin is recommended. […] Although lesions are typically well demarcated, the actual extent of the disease may be well beyond the clinical margins. […] Mohs micrographic surgery is an excellent method for larger lesions, poorly demarcated lesions, recurrent lesions on the head and neck, or areas where tissue sparing is vital, such as digital or genital lesions. […] It offers the highest cure rate of all treatment modalities, and, because relatively thin layers are taken only in areas of proven tumor, it is a tissue-sparing procedure.

• #26 Bowen Disease Treatment & Management: Medical Care, Surgical Care, Prevention

  https://emedicine.medscape.com/article/1100113-treatment

  Curettage and electrodesiccation, cryotherapy, and laser ablation are blind surgical methods (no pathologic confirmation of removal) that are established treatment modalities for Bowen disease. […] Curettage and electrodesiccation is a common and safe modality. […] Treatment efficacy is largely determined by the skill of the clinician. […] Cryotherapy is another common therapeutic option, especially for single and small lesions. […] Suggested regimens in the literature include a single 30-second freeze-thaw cycle, 2 freeze-thaw cycles of 20 seconds with a thaw period, or up to 3 single treatments of 20 seconds at intervals of several weeks. […] The risk of poor wound healing (eg, hypopigmented scarring) increase with prolonged freezing times. […] Counsel at-risk individuals in the use of sunscreens, photoprotective clothing, and other measures to minimize further actinic damage. […] Patients with a history of any type of skin cancer should be evaluated with a total body skin examination every 6-12 months. […] One study demonstrated the use of dermatoscopy when following Bowen disease.

• #27 Bowen Disease Treatment & Management: Medical Care, Surgical Care, Prevention

  https://emedicine.medscape.com/article/1100113-treatment

  Curettage and electrodesiccation, cryotherapy, and laser ablation are blind surgical methods (no pathologic confirmation of removal) that are established treatment modalities for Bowen disease. […] Curettage and electrodesiccation is a common and safe modality. […] Treatment efficacy is largely determined by the skill of the clinician. […] Cryotherapy is another common therapeutic option, especially for single and small lesions. […] Suggested regimens in the literature include a single 30-second freeze-thaw cycle, 2 freeze-thaw cycles of 20 seconds with a thaw period, or up to 3 single treatments of 20 seconds at intervals of several weeks. […] The risk of poor wound healing (eg, hypopigmented scarring) increase with prolonged freezing times. […] Counsel at-risk individuals in the use of sunscreens, photoprotective clothing, and other measures to minimize further actinic damage. […] Patients with a history of any type of skin cancer should be evaluated with a total body skin examination every 6-12 months. […] One study demonstrated the use of dermatoscopy when following Bowen disease.

• #28 Bowen Disease Treatment & Management: Medical Care, Surgical Care, Prevention

  https://emedicine.medscape.com/article/1100113-treatment

  Curettage and electrodesiccation, cryotherapy, and laser ablation are blind surgical methods (no pathologic confirmation of removal) that are established treatment modalities for Bowen disease. […] Curettage and electrodesiccation is a common and safe modality. […] Treatment efficacy is largely determined by the skill of the clinician. […] Cryotherapy is another common therapeutic option, especially for single and small lesions. […] Suggested regimens in the literature include a single 30-second freeze-thaw cycle, 2 freeze-thaw cycles of 20 seconds with a thaw period, or up to 3 single treatments of 20 seconds at intervals of several weeks. […] The risk of poor wound healing (eg, hypopigmented scarring) increase with prolonged freezing times. […] Counsel at-risk individuals in the use of sunscreens, photoprotective clothing, and other measures to minimize further actinic damage. […] Patients with a history of any type of skin cancer should be evaluated with a total body skin examination every 6-12 months. […] One study demonstrated the use of dermatoscopy when following Bowen disease.

• #29 Non-surgical management of actinic keratosis, Bowen’s disease and non-melanoma skin cancer | The PMFA Journal

  https://www.thepmfajournal.com/features/post/non-surgical-management-of-actinic-keratosis-bowen-s-disease-and-non-melanoma-skin-cancer

  Radiotherapy (RT) is the use of radiation to treat cancer by directing high energy radiation (typically X-ray) to target and destroy cancer cells. RT is the only non-surgical treatment option for SCC with sufficient evidence supporting its role. […] NMSCs are among the most common malignancies in the UK, demonstrating a trend of increased incidence over the past decades. Despite surgical treatment remaining the standard of care for the majority of NMSCs, non-surgical modalities are important in the management of pre-cancerous lesions, and can be appropriate alternatives in the treatment of malignant ones.

• #30 Bowen Disease Treatment & Management: Medical Care, Surgical Care, Prevention

  https://emedicine.medscape.com/article/1100113-treatment

  It is used clinically as a 5% cream once or twice daily for a variable period, ranging from 1 week to 3 months. […] The main advantage is easy self-application by patients. […] The main adverse effect is irritation with erosions and ulcerations that may last several weeks. […] A disadvantage is that it may not be able to penetrate deep enough to treat any deep follicular extension of the tumor cells. […] Imiquimod 5% cream, a topical immune response modifier, applied 3-7 d/wk, appears to possibly be a successful treatment option for Bowen disease. […] Topical treatment for perianal Bowen disease may minimize the risk of scarring, poor wound healing, and functional impairment. […] Consider x-ray or grenz-ray radiation therapy for poor surgical candidates or patients with multiple lesions.

• #31 Bowen’s disease – treatment and symptoms | healthdirect

  https://www.healthdirect.gov.au/bowens-disease

  Bowen’s disease is a very early form of skin cancer. […] There are many ways to treat Bowen’s disease. […] Because it is such an early cancer, it can usually be cured. […] The best type of treatment for you will depend on: the size and thickness of the Bowen’s disease, where it is on your body, your age, your health in general. […] You can choose what treatment to have. […] Sometimes, Bowen’s disease comes back after treatment. It is important to go to follow-up appointments with your doctor or dermatologist. […] It’s very important to protect yourself from sun exposure to prevent skin cancers developing. […] You should also have your skin checked by a doctor at least once a year. […] If Bowen’s disease is not treated, a there is a chance it could become an invasive skin cancer called a squamous cell carcinoma. That means it can spread locally or to other parts of the body. […] You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.

• #32 Bowen’s disease

  https://www.pcds.org.uk/patient-info-leaflets/bowens-disease

  It is important to ask a healthcare professional for a full skin examination to check for other skin lesions that may also need attention. […] In terms of treatment, this depends on various factors including size site (where the Bowens disease is located), and your general health. […] Treatment options include: Efudix cream (5-FU cream) applied thinly once a day to the affected area and up to 4 mm of normal surrounding skin, usually for 4 weeks; occasionally your doctor may recommend longer. […] Cryosurgery this is the same cold spray (liquid nitrogen) used to treat warts. […] Photodynamic therapy this involves the combination of a cream with a special light source. […] Skin surgery given the usual good response to non-surgical treatments, the main indications for surgery are if the diagnosis is uncertain and/or the lesion is not responding to treatment. […] It is important that you discuss treatment options with your specialist (or GP) and ask about anything that you do not understand.

• #33

  https://journals.lww.com/idoj/fulltext/2022/13020/bowen_s_disease.2.aspx

  Bowen’s disease (BD) is an in-situ squamous cell carcinoma of epidermis. […] The treatment depends on various factors like site, size, immune status, patient’s age, esthetic outcome, etc. The available therapeutic modalities include topical chemotherapy, surgical modalities, light-based modalities, and destructive therapies. […] It requires a combined effort of dermatologist, oncosurgeon, and plastic surgeon to plan and execute the management in various presentations of BD. […] The treatment modality depends on factors such as the tumor size, location, thickness, number of lesions, patient’s age, immune status, comorbidities, concomitant medication intake, compliance, esthetic outcome, equipment availability, and preference of the patient along with clinician’s expertise. […] Each therapeutic modality has its own place in the treatment armamentarium; hence, the treating physician should weigh its merits and demerits.

• #34 Bowen’s disease – treatment and symptoms | healthdirect

  https://www.healthdirect.gov.au/bowens-disease

  Bowen’s disease is a very early form of skin cancer. […] There are many ways to treat Bowen’s disease. […] Because it is such an early cancer, it can usually be cured. […] The best type of treatment for you will depend on: the size and thickness of the Bowen’s disease, where it is on your body, your age, your health in general. […] You can choose what treatment to have. […] Sometimes, Bowen’s disease comes back after treatment. It is important to go to follow-up appointments with your doctor or dermatologist. […] It’s very important to protect yourself from sun exposure to prevent skin cancers developing. […] You should also have your skin checked by a doctor at least once a year. […] If Bowen’s disease is not treated, a there is a chance it could become an invasive skin cancer called a squamous cell carcinoma. That means it can spread locally or to other parts of the body. […] You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.

• #35

  https://journals.lww.com/idoj/fulltext/2022/13020/bowen_s_disease.2.aspx

  Because BD commonly occurs in old individuals, frequently located in regions with poor wound healing, noninvasive treatments are preferred. […] The available therapeutic options are topical chemotherapy, light-based procedures, surgical modality, and destructive modality. […] The treatment varies from topical agents to surgical methods. The first choice is often decided by the physician based on the site, size, immunity, and available facilities. […] In case of poor wound healing, PDT is preferred followed by 5-FU and imiquimod. […] The choice of therapy in BD is depicted in [Figure 7]. […] It requires a combined effort of dermatologist, oncosurgeon, and plastic surgeon to plan and execute the management in various presentations of BD.

• #36

  https://journals.lww.com/idoj/fulltext/2022/13020/bowen_s_disease.2.aspx

  Because BD commonly occurs in old individuals, frequently located in regions with poor wound healing, noninvasive treatments are preferred. […] The available therapeutic options are topical chemotherapy, light-based procedures, surgical modality, and destructive modality. […] The treatment varies from topical agents to surgical methods. The first choice is often decided by the physician based on the site, size, immunity, and available facilities. […] In case of poor wound healing, PDT is preferred followed by 5-FU and imiquimod. […] The choice of therapy in BD is depicted in [Figure 7]. […] It requires a combined effort of dermatologist, oncosurgeon, and plastic surgeon to plan and execute the management in various presentations of BD.

• #37 Bowen’s disease – British Skin Foundation

  https://knowyourskin.britishskinfoundation.org.uk/condition/bowens-disease/

  Radiotherapy and laser are other therapies occasionally used for the treatment of SCC in situ. […] A particular problem with SCC in situ is that it frequently occurs on the lower legs. The skin on the lower legs is often tight and sometimes quite fragile, especially in older people. Healing in this area is slow. […] From now on, you should take precautions to prevent additional patches of squamous cell carcinoma in situ developing: […] Sun protection is recommended for all patients. It is advisable to protect the skin from further sun damage (for example, by wearing a hat, long sleeves and a sunscreen with a high sun protection factor). […] The British Association of Dermatologists recommend that you tell your doctor about any changes to a mole or patch of skin. […] Routine sun protection is rarely necessary in the UK for people of colour, particularly those with black or dark brown skin tones. However, there are important exceptions to this; for example, sun protection is important if you have a skin condition, such as photosensitivity, vitiligo or lupus, or if you have a high risk of skin cancer, especially if you are taking immunosuppressive treatments (including organ transplant recipients) or if you are genetically pre-disposed to skin cancer. […] The evidence relating to the health effects of serum vitamin D levels, exposure to sunlight and vitamin D intake, is inconclusive.

• #38

  https://rms.cornwall.nhs.uk/primary_care_clinical_referral_criteria/rms/primary_care_clinical_referral_criteria/dermatology/bowens_disease

  Straightforward Bowens disease should be managed in primary care. A punch biopsy is not usually necessary but can be useful if there is a poor response to treatment/diagnostic uncertainty. A 2ww referral is required if there are any concerns about SCC […] FIRST-LINE TREATMENT: Efudix cream (5-FU cream) OD 4/52. Hands should be washed thoroughly after application. The treated area must be left uncovered and the cream washed off approximately 8 hours after application. Warn the patient to expect some redness, crusting and mild discomfort. After four weeks stop the treatment and consider using a mild topical steroid eg 1% Hydrocortisone or Eumovate cream BD for two weeks to help settle down any inflammation […] POORLY HEALING AREAS: Caution with lower legs as may develop ulceration (higher risk with cryotherapy). Can use Efudix cautiously: e.g OD for 3/52 then break before restarting treatment again. Or can observe in patients with reduced life expectancy.

• #39 Interventions for cutaneous Bowen’s disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6464151/

  Bowen’s disease is the clinical term for in situ squamous cell carcinoma of the skin. Cutaneous lesions present as largely asymptomatic, well-defined, scaly erythematous patches on sun-exposed skin. In general, people with Bowen’s disease have an excellent prognosis because the disease is typically slow-growing and responds favourably to treatment. Lesions are persistent and can be progressive, with a small potential (estimated to be 3%) to develop into invasive squamous cell carcinoma. The relative effectiveness of the available treatments is not known for Bowen’s disease, and this review attempts to address which is the most effective intervention, with the least side effects, for cutaneous Bowen’s disease. […] We included 9 studies, with a total of 363 participants. One study demonstrated statistically significantly greater clearance of lesions of Bowen’s disease with MALPDT (methyl aminolevulinate with photodynamic therapy) when compared with placeboPDT (RR (risk ratio) 1.68, 95% CI (confidence interval) 1.12 to 2.52; n = 148) or cryotherapy (RR 1.17, 95% CI 1.01 to 1.37; n = 215), but there was no significant difference when MALPDT was compared to 5FU (5-fluorouracil). One study demonstrated statistically significantly greater clearance of lesions with ALAPDT (5-aminolevulinic acid with photodynamic therapy) versus 5FU (RR 1.83, 95% CI 1.10 to 3.06; n = 66), but no statistically significant difference in recurrence rates at 12 months (RR 0.33, 95% CI 0.07 to 1.53).

• #40 Interventions for cutaneous Bowen’s disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6464151/

  Bowen’s disease is the clinical term for in situ squamous cell carcinoma of the skin. Cutaneous lesions present as largely asymptomatic, well-defined, scaly erythematous patches on sun-exposed skin. In general, people with Bowen’s disease have an excellent prognosis because the disease is typically slow-growing and responds favourably to treatment. Lesions are persistent and can be progressive, with a small potential (estimated to be 3%) to develop into invasive squamous cell carcinoma. The relative effectiveness of the available treatments is not known for Bowen’s disease, and this review attempts to address which is the most effective intervention, with the least side effects, for cutaneous Bowen’s disease. […] We included 9 studies, with a total of 363 participants. One study demonstrated statistically significantly greater clearance of lesions of Bowen’s disease with MALPDT (methyl aminolevulinate with photodynamic therapy) when compared with placeboPDT (RR (risk ratio) 1.68, 95% CI (confidence interval) 1.12 to 2.52; n = 148) or cryotherapy (RR 1.17, 95% CI 1.01 to 1.37; n = 215), but there was no significant difference when MALPDT was compared to 5FU (5-fluorouracil). One study demonstrated statistically significantly greater clearance of lesions with ALAPDT (5-aminolevulinic acid with photodynamic therapy) versus 5FU (RR 1.83, 95% CI 1.10 to 3.06; n = 66), but no statistically significant difference in recurrence rates at 12 months (RR 0.33, 95% CI 0.07 to 1.53).

• #41 Interventions for cutaneous Bowen’s disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6464151/

  Bowen’s disease is the clinical term for in situ squamous cell carcinoma of the skin. Cutaneous lesions present as largely asymptomatic, well-defined, scaly erythematous patches on sun-exposed skin. In general, people with Bowen’s disease have an excellent prognosis because the disease is typically slow-growing and responds favourably to treatment. Lesions are persistent and can be progressive, with a small potential (estimated to be 3%) to develop into invasive squamous cell carcinoma. The relative effectiveness of the available treatments is not known for Bowen’s disease, and this review attempts to address which is the most effective intervention, with the least side effects, for cutaneous Bowen’s disease. […] We included 9 studies, with a total of 363 participants. One study demonstrated statistically significantly greater clearance of lesions of Bowen’s disease with MALPDT (methyl aminolevulinate with photodynamic therapy) when compared with placeboPDT (RR (risk ratio) 1.68, 95% CI (confidence interval) 1.12 to 2.52; n = 148) or cryotherapy (RR 1.17, 95% CI 1.01 to 1.37; n = 215), but there was no significant difference when MALPDT was compared to 5FU (5-fluorouracil). One study demonstrated statistically significantly greater clearance of lesions with ALAPDT (5-aminolevulinic acid with photodynamic therapy) versus 5FU (RR 1.83, 95% CI 1.10 to 3.06; n = 66), but no statistically significant difference in recurrence rates at 12 months (RR 0.33, 95% CI 0.07 to 1.53).

• #42 Interventions for cutaneous Bowen’s disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6464151/

  Overall, there has been very little good-quality research on treatments for Bowen’s disease. There is limited evidence from single studies to suggest MALPDT is an effective treatment. Although cosmetic outcomes appear favourable with PDT, five-year follow-up data are needed. Significantly more lesions cleared with MALPDT compared to cryotherapy. No significant difference in clearance was seen when MALPDT was compared with 5FU, but one study found a significant difference in clearance in favour of ALAPDT when compared to 5FU. There was no significant difference in clearance when cryotherapy was compared to 5FU. […] Specific recommendations cannot be made from these data, so this review cannot give firm conclusions about the comparative effectiveness of treatments. There is a clear need for future research to focus on a range of different studies comparing various therapies with each other, and in particular to surgical treatments to provide high-quality evidence to guide clinical practice. The age group, number and size of lesions, sites affected, and immunological status may all influence therapeutic choices. Longer-term follow up (up to 10 years) is needed to determine the effect of treatments on risk of progression of lesions of Bowen’s disease to squamous cell carcinoma.

• #43 Interventions for cutaneous Bowen’s disease – PubMed

  https://pubmed.ncbi.nlm.nih.gov/23794286/

  Overall, there has been very little good-quality research on treatments for Bowen’s disease. There is limited evidence from single studies to suggest MAL-PDT is an effective treatment. Although cosmetic outcomes appear favourable with PDT, five-year follow-up data are needed. Significantly more lesions cleared with MAL-PDT compared to cryotherapy. No significant difference in clearance was seen when MAL-PDT was compared with 5-FU, but one study found a significant difference in clearance in favour of ALA-PDT when compared to 5-FU. There was no significant difference in clearance when cryotherapy was compared to 5-FU. […] More studies are required in the immunosuppressed populations as different therapeutic options may be preferable. Specific recommendations cannot be made from the data in this review, so we cannot give firm conclusions about the comparative effectiveness of treatments.

• #44 Spot Check | Bowen’s disease (squamous cell carcinoma in situ)

  https://spotcheck.clinic/conditions/skin-cancers/bowens/

  Bowen’s disease is usually easy to treat. Because it affects the surface layers of the skin, topical treatments are effective and may be preferred in cases where a good cosmetic outcome is desired, or surgery is inappropriate. […] Other treatments include excision, cryotherapy and photodynamic therapy. […] Regular check-ups will help detect new skin cancers. […] Check your skin regularly for signs of skin cancer. Be alert for “ugly duckling” spots that don’t resemble your other spots or moles. […] Due to a higher risk of skin cancers in future, including potentially serious squamous cell carcinomas, have a yearly full body skin check with an experienced skin cancer doctor. […] Even if you’ve already been diagnosed with skin cancer, it’s not too late to reduce your risk. Wear sunscreen whenever the UV index is over 3, cover up with long sleeves, sunglasses and a hat, and stay in shaded areas when possible.

• #45 Bowen Disease Treatment & Management: Medical Care, Surgical Care, Prevention

  https://emedicine.medscape.com/article/1100113-treatment

  For specific guidelines and recommendations, please see British Association of Dermatologists guidelines for the management of people with squamous cell carcinoma in situ (Bowens disease) 2022. […] Each treatment modality has advantages and disadvantages. Choosing the best therapeutic option involves an analysis of various factors such as lesional size, number, site, degree of functional impairment, modality availability, and cost. […] Because most treatments have a recurrence risk, follow-up at 6-12 months is recommended to evaluate for recurrence. […] Factors that dictate a shorter follow-up period include history of past recurrence, presence of multiple lesions, lesions in high-risk locations, and immunosuppression. […] 5-Fluorouracil is a topical antineoplastic agent that interferes with DNA synthesis via inhibition of thymidylate synthetase and subsequently cell proliferation.

• #46 Bowen Disease Treatment & Management: Medical Care, Surgical Care, Prevention

  https://emedicine.medscape.com/article/1100113-treatment

  For specific guidelines and recommendations, please see British Association of Dermatologists guidelines for the management of people with squamous cell carcinoma in situ (Bowens disease) 2022. […] Each treatment modality has advantages and disadvantages. Choosing the best therapeutic option involves an analysis of various factors such as lesional size, number, site, degree of functional impairment, modality availability, and cost. […] Because most treatments have a recurrence risk, follow-up at 6-12 months is recommended to evaluate for recurrence. […] Factors that dictate a shorter follow-up period include history of past recurrence, presence of multiple lesions, lesions in high-risk locations, and immunosuppression. […] 5-Fluorouracil is a topical antineoplastic agent that interferes with DNA synthesis via inhibition of thymidylate synthetase and subsequently cell proliferation.

• #47 Bowen's disease

  https://www.pcds.org.uk/clinical-guidance/bowens-disease

  Efudix cream (5-FU cream) OD for four weeks. Hands should be washed thoroughly after application. The treated area must be left uncovered and the cream washed off approximately 8 hours after application. Warn the patient to expect some redness, crusting and mild discomfort. After four weeks stop the treatment and consider using a mild topical steroid eg 1% Hydrocortisone or Eumovate cream BD for two weeks to help settle down any inflammation. […] Although the risk of leg ulceration is greater with cryosurgery, it can also happen with Efudix cream, as such a watch and wait policy can be offered for lesions on the gaiter area of the legs in patients with a reduced life expectancy. […] Patients should be followed up at three months. The presence of any remaining rough scale would suggest that the lesion has not fully responded to treatment and that more is required, whereas the presence of smooth skin, sometimes with associated post-inflammatory hyperpigmentation (especially on the lower legs), suggests that the lesion has responded well, in which case further follow-up is not required.

• #48 Bowen’s Disease

  https://www.drsearles.ca/bowen-s-disease

  For this reason, dermatologists usually treat, or at least keep an eye on, Bowen’s disease […] Yes Bowen’s disease can be curred, as it is confined to the surface of the skin, there are a variety of ways in which this can be achieved. […] A number of treatments are available for Bowens disease: […] However, a particular problem is that Bowens disease is frequently found on the lower leg – where the skin is often tight and sometimes quite fragile, especially in older patients. Healing there is slow. Many factors, therefore, play a part in selecting the right treatment: […] From now on, you should take sensible precautions to stop another patch of Bowens disease coming up. This means wearing clothing that protects you against the sun, avoiding strong sunlight, and using a sun block with a sun protection factor (SPF) of at least 30.

• #49 Bowen’s Disease

  https://www.drsearles.ca/bowen-s-disease

  Check your skin regularly for new lesions. […] The smaller your patch of Bowens disease is, the better the results of treatment are likely to be. If you think another one is coming up, see your doctor about it early rather than late. […] If your patch changes in any way (bleeds, ulcerates or develops a lump) contact your doctor quickly as this could be the start of an invasive skin cancer.

• #50 Bowen’s Disease

  https://www.drsearles.ca/bowen-s-disease

  Check your skin regularly for new lesions. […] The smaller your patch of Bowens disease is, the better the results of treatment are likely to be. If you think another one is coming up, see your doctor about it early rather than late. […] If your patch changes in any way (bleeds, ulcerates or develops a lump) contact your doctor quickly as this could be the start of an invasive skin cancer.

• #51 Bowen’s Disease

  https://www.drsearles.ca/bowen-s-disease

  Check your skin regularly for new lesions. […] The smaller your patch of Bowens disease is, the better the results of treatment are likely to be. If you think another one is coming up, see your doctor about it early rather than late. […] If your patch changes in any way (bleeds, ulcerates or develops a lump) contact your doctor quickly as this could be the start of an invasive skin cancer.

• #52 Bowen’s disease – treatment and symptoms | healthdirect

  https://www.healthdirect.gov.au/bowens-disease

  Bowen’s disease is a very early form of skin cancer. […] There are many ways to treat Bowen’s disease. […] Because it is such an early cancer, it can usually be cured. […] The best type of treatment for you will depend on: the size and thickness of the Bowen’s disease, where it is on your body, your age, your health in general. […] You can choose what treatment to have. […] Sometimes, Bowen’s disease comes back after treatment. It is important to go to follow-up appointments with your doctor or dermatologist. […] It’s very important to protect yourself from sun exposure to prevent skin cancers developing. […] You should also have your skin checked by a doctor at least once a year. […] If Bowen’s disease is not treated, a there is a chance it could become an invasive skin cancer called a squamous cell carcinoma. That means it can spread locally or to other parts of the body. […] You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.

• #53 Non-surgical management of actinic keratosis, Bowen’s disease and non-melanoma skin cancer | The PMFA Journal

  https://www.thepmfajournal.com/features/post/non-surgical-management-of-actinic-keratosis-bowen-s-disease-and-non-melanoma-skin-cancer

  Bowens disease (BD) is histologically characterised as SCC in situ. Clinically it tends to present as a discrete, scaly, erythematous patch or plaque, often affecting the lower legs in women and on the scalp and ears in men. Lesions may be confused with psoriasis or eczema. […] Several aetiological factors of BD have been described; ultraviolet (UV) radiation, radiotherapy, arsenic ingestion, immunosuppression and human papillomavirus infection are associated with increased risks of developing BD. Development of a lump or ulcer, pain or bleeding within BD may indicate progression to SCC, which occurs in about 3-5% of cases. […] Surgical management remains the mainstay of treatment of BCC and SCC, with Mohs micrographic surgery often regarded as the gold standard of treatment for the former. However, in cases where tissue sparing or non-surgical treatment modalities are preferred, or in low-risk tumours, topical or non-invasive treatment options can sometimes be used. A range of different non-surgical treatment options exist for the treatment of AK, BD and some cases of NMSC; new agents continue to be developed and added to the list of choices available.

• #54 Intraepidermal squamous cell carcinoma, intraepidermal SCC, Bowen’s disease

  https://dermnetnz.org/topics/intraepidermal-squamous-cell-carcinoma

  Intraepidermal squamous cell carcinoma (SCC) is a common superficial form of keratinocyte cancer. It is also known as Bowen disease, intraepidermal carcinoma (IEC) and carcinoma in situ (SCC in situ). […] As intraepidermal SCC is confined to the surface of the skin, there are various ways to remove it. Recurrence rates are high, whatever method is used, particularly in immune suppressed patients. […] Meticulous sun protection at any time of life can reduce the number of intraepidermal SCCs and is particularly important for ageing, sun-damaged white skin; and in patients that are immune suppressed by disease, for example with human immunodeficiency virus (HIV) infection, or by medications. […] Patients that have been treated for intraepidermal SCC are at risk of developing new lesions of intraepidermal SCC. They are also at increased risk of other skin cancers, especially squamous cell carcinoma, basal cell carcinoma and melanoma.

• #55 Spot Check | Bowen’s disease (squamous cell carcinoma in situ)

  https://spotcheck.clinic/conditions/skin-cancers/bowens/

  Bowen’s disease is usually easy to treat. Because it affects the surface layers of the skin, topical treatments are effective and may be preferred in cases where a good cosmetic outcome is desired, or surgery is inappropriate. […] Other treatments include excision, cryotherapy and photodynamic therapy. […] Regular check-ups will help detect new skin cancers. […] Check your skin regularly for signs of skin cancer. Be alert for “ugly duckling” spots that don’t resemble your other spots or moles. […] Due to a higher risk of skin cancers in future, including potentially serious squamous cell carcinomas, have a yearly full body skin check with an experienced skin cancer doctor. […] Even if you’ve already been diagnosed with skin cancer, it’s not too late to reduce your risk. Wear sunscreen whenever the UV index is over 3, cover up with long sleeves, sunglasses and a hat, and stay in shaded areas when possible.

• #56 Intraepidermal squamous cell carcinoma, intraepidermal SCC, Bowen’s disease

  https://dermnetnz.org/topics/intraepidermal-squamous-cell-carcinoma

  Intraepidermal squamous cell carcinoma (SCC) is a common superficial form of keratinocyte cancer. It is also known as Bowen disease, intraepidermal carcinoma (IEC) and carcinoma in situ (SCC in situ). […] As intraepidermal SCC is confined to the surface of the skin, there are various ways to remove it. Recurrence rates are high, whatever method is used, particularly in immune suppressed patients. […] Meticulous sun protection at any time of life can reduce the number of intraepidermal SCCs and is particularly important for ageing, sun-damaged white skin; and in patients that are immune suppressed by disease, for example with human immunodeficiency virus (HIV) infection, or by medications. […] Patients that have been treated for intraepidermal SCC are at risk of developing new lesions of intraepidermal SCC. They are also at increased risk of other skin cancers, especially squamous cell carcinoma, basal cell carcinoma and melanoma.

• #57 Intraepidermal squamous cell carcinoma, intraepidermal SCC, Bowen’s disease

  https://dermnetnz.org/topics/intraepidermal-squamous-cell-carcinoma

  Intraepidermal squamous cell carcinoma (SCC) is a common superficial form of keratinocyte cancer. It is also known as Bowen disease, intraepidermal carcinoma (IEC) and carcinoma in situ (SCC in situ). […] As intraepidermal SCC is confined to the surface of the skin, there are various ways to remove it. Recurrence rates are high, whatever method is used, particularly in immune suppressed patients. […] Meticulous sun protection at any time of life can reduce the number of intraepidermal SCCs and is particularly important for ageing, sun-damaged white skin; and in patients that are immune suppressed by disease, for example with human immunodeficiency virus (HIV) infection, or by medications. […] Patients that have been treated for intraepidermal SCC are at risk of developing new lesions of intraepidermal SCC. They are also at increased risk of other skin cancers, especially squamous cell carcinoma, basal cell carcinoma and melanoma.

• #58

  https://journals.lww.com/idoj/fulltext/2022/13020/bowen_s_disease.2.aspx

  Bowen’s disease (BD) is an in-situ squamous cell carcinoma of epidermis. […] The treatment depends on various factors like site, size, immune status, patient’s age, esthetic outcome, etc. The available therapeutic modalities include topical chemotherapy, surgical modalities, light-based modalities, and destructive therapies. […] It requires a combined effort of dermatologist, oncosurgeon, and plastic surgeon to plan and execute the management in various presentations of BD. […] The treatment modality depends on factors such as the tumor size, location, thickness, number of lesions, patient’s age, immune status, comorbidities, concomitant medication intake, compliance, esthetic outcome, equipment availability, and preference of the patient along with clinician’s expertise. […] Each therapeutic modality has its own place in the treatment armamentarium; hence, the treating physician should weigh its merits and demerits.

• #59

  https://journals.lww.com/idoj/fulltext/2022/13020/bowen_s_disease.2.aspx

  Because BD commonly occurs in old individuals, frequently located in regions with poor wound healing, noninvasive treatments are preferred. […] The available therapeutic options are topical chemotherapy, light-based procedures, surgical modality, and destructive modality. […] The treatment varies from topical agents to surgical methods. The first choice is often decided by the physician based on the site, size, immunity, and available facilities. […] In case of poor wound healing, PDT is preferred followed by 5-FU and imiquimod. […] The choice of therapy in BD is depicted in [Figure 7]. […] It requires a combined effort of dermatologist, oncosurgeon, and plastic surgeon to plan and execute the management in various presentations of BD.

• #60 Practice Nursing – Managing Bowen’s disease in primary care settings

  https://www.practicenursing.com/content/clinical/managing-bowens-disease-in-primary-care-settings/

  Bowen’s disease is a rare condition, considered a precursor to squamous cell carcinoma. […] This article has hoped to give an overview of risk factors, signs and symptoms, treatment, and complications with the aim of giving nurses and non-medical prescribers increased confidence in recognising this disease. […] It is hoped that the information provided will give nurses and non-medical prescribers more confidence in recognising this disease with the aim of getting patients an earlier diagnosis, reducing the risk of complications, and improving quality of life.

• #61 Bowen's disease

  https://www.pcds.org.uk/clinical-guidance/bowens-disease

  Bowen disease is characterised by full thickness epidermal dysplasia and disordered differentiation with loss of epithelial polarity. The intraepidermal portion of cutaneous adnexae is generally affected. Parakeratosis and acanthosis are usually present and keratinocytes show variable pleomorphism, nuclear hyperchromasia and nuclear enlargement. […] Examine for other relevant skin lesions. Provide a patient information leaflet on Bowen’s disease. Direct patients to the section of this website on self-examination and also UV protection. […] A single freeze-thaw cycle with cryosurgery for 20-30 seconds – avoid in the gaiter area of the leg and other areas of poor skin healing. For larger patches treatment may be better tolerated if half of the lesion is treated initially and the other half six weeks later.

• #62 Bowen’s disease – British Skin Foundation

  https://knowyourskin.britishskinfoundation.org.uk/condition/bowens-disease/

  Radiotherapy and laser are other therapies occasionally used for the treatment of SCC in situ. […] A particular problem with SCC in situ is that it frequently occurs on the lower legs. The skin on the lower legs is often tight and sometimes quite fragile, especially in older people. Healing in this area is slow. […] From now on, you should take precautions to prevent additional patches of squamous cell carcinoma in situ developing: […] Sun protection is recommended for all patients. It is advisable to protect the skin from further sun damage (for example, by wearing a hat, long sleeves and a sunscreen with a high sun protection factor). […] The British Association of Dermatologists recommend that you tell your doctor about any changes to a mole or patch of skin. […] Routine sun protection is rarely necessary in the UK for people of colour, particularly those with black or dark brown skin tones. However, there are important exceptions to this; for example, sun protection is important if you have a skin condition, such as photosensitivity, vitiligo or lupus, or if you have a high risk of skin cancer, especially if you are taking immunosuppressive treatments (including organ transplant recipients) or if you are genetically pre-disposed to skin cancer. […] The evidence relating to the health effects of serum vitamin D levels, exposure to sunlight and vitamin D intake, is inconclusive.

• #63 Spot Check | Bowen’s disease (squamous cell carcinoma in situ)

  https://spotcheck.clinic/conditions/skin-cancers/bowens/

  Bowen’s disease is usually easy to treat. Because it affects the surface layers of the skin, topical treatments are effective and may be preferred in cases where a good cosmetic outcome is desired, or surgery is inappropriate. […] Other treatments include excision, cryotherapy and photodynamic therapy. […] Regular check-ups will help detect new skin cancers. […] Check your skin regularly for signs of skin cancer. Be alert for “ugly duckling” spots that don’t resemble your other spots or moles. […] Due to a higher risk of skin cancers in future, including potentially serious squamous cell carcinomas, have a yearly full body skin check with an experienced skin cancer doctor. […] Even if you’ve already been diagnosed with skin cancer, it’s not too late to reduce your risk. Wear sunscreen whenever the UV index is over 3, cover up with long sleeves, sunglasses and a hat, and stay in shaded areas when possible.

• #64 Bowen’s Disease Treatment Reading – Causes, Symptoms & Treatments | Derma

  https://www.dermareading.co.uk/bowens-disease

  Bowen’s disease typically presents as a patch on the skin that has clear edges, and does not heal. […] It is vital that patients worried about a lesion visit their GPs, who are often able to diagnose pre-cancerous lesions. The GP may refer the patient to a dermatologist for treatment which may include a biopsy – if they feel it is appropriate. […] Patients can assist in managing their Bowens disease by self-monitoring their skin for any changes, undergoing annual follow-up appointments, and being vigilant against lifestyle factors that increase risk. […] Treatment of Bowens Disease at Derma […] There are a number of treatment options for Bowen’s disease, and the dermatologist will help you identify which are suitable, and which option is best for you. […] Some patients lesions can be treated with cryotherapy, in which liquid nitrogen is sprayed onto the affected area. Photodynamic therapy, also known as PDT uses a light source to destroy the abnormal cells.

• #65 Bowen’s disease – treatment and symptoms | healthdirect

  https://www.healthdirect.gov.au/bowens-disease

  Bowen’s disease is a very early form of skin cancer. […] There are many ways to treat Bowen’s disease. […] Because it is such an early cancer, it can usually be cured. […] The best type of treatment for you will depend on: the size and thickness of the Bowen’s disease, where it is on your body, your age, your health in general. […] You can choose what treatment to have. […] Sometimes, Bowen’s disease comes back after treatment. It is important to go to follow-up appointments with your doctor or dermatologist. […] It’s very important to protect yourself from sun exposure to prevent skin cancers developing. […] You should also have your skin checked by a doctor at least once a year. […] If Bowen’s disease is not treated, a there is a chance it could become an invasive skin cancer called a squamous cell carcinoma. That means it can spread locally or to other parts of the body. […] You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.

• #66 Bowen’s disease – treatment and symptoms | healthdirect

  https://www.healthdirect.gov.au/bowens-disease

  Bowen’s disease is a very early form of skin cancer. […] There are many ways to treat Bowen’s disease. […] Because it is such an early cancer, it can usually be cured. […] The best type of treatment for you will depend on: the size and thickness of the Bowen’s disease, where it is on your body, your age, your health in general. […] You can choose what treatment to have. […] Sometimes, Bowen’s disease comes back after treatment. It is important to go to follow-up appointments with your doctor or dermatologist. […] It’s very important to protect yourself from sun exposure to prevent skin cancers developing. […] You should also have your skin checked by a doctor at least once a year. […] If Bowen’s disease is not treated, a there is a chance it could become an invasive skin cancer called a squamous cell carcinoma. That means it can spread locally or to other parts of the body. […] You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.

• #67 Bowen’s disease

  https://www.nhs.uk/conditions/bowens-disease/

  Bowen’s disease usually appears as a patch on the skin that has clear edges and does not heal. […] It’s important to get a proper diagnosis, as Bowen’s disease can look like other conditions, such as psoriasis or eczema. […] There are a number of treatment options for Bowen’s disease. Talk to your dermatologist about which treatment is most suitable for you. […] After having treatment for Bowen’s disease, you may need follow-up appointments with your dermatologist or GP to see if you need any further treatment. […] See a GP if an existing patch starts to bleed, change in appearance or develops a lump do not wait for your follow-up appointment. […] Make sure you protect your skin from the sun wear protective clothing and use a sunscreen with a high sun protection factor (SPF) of at least 30.

• #68 Bowens disease – Ask the nurses – Cancer Chat | Cancer Research UK

  https://cancerchat.cancerresearchuk.org/f/ask-the-nurses/116991/bowens-disease

  I am sorry to hear you have Bowen’s disease and appreciate the concerns you have about long term treatment. […] As nurses we cannot recommend treatment for individual patients. There is more information about Bowen’s disease on our website alongside the commonly used treatments for this condition. Treatment decisions are decided by the skin specialist involved in a patients care so do discuss the concerns you have with your doctor and ask if there are alternative options. […] Please get back to us if you need any more information or support. You may find it helpful to talk things through with one of the nurses on our helpline. The number to call is Freephone 0808 800 4040 and the lines are open from 9am till 5pm Monday to Friday.

• #69

  https://journals.lww.com/idoj/fulltext/2022/13020/bowen_s_disease.2.aspx

  Because BD commonly occurs in old individuals, frequently located in regions with poor wound healing, noninvasive treatments are preferred. […] The available therapeutic options are topical chemotherapy, light-based procedures, surgical modality, and destructive modality. […] The treatment varies from topical agents to surgical methods. The first choice is often decided by the physician based on the site, size, immunity, and available facilities. […] In case of poor wound healing, PDT is preferred followed by 5-FU and imiquimod. […] The choice of therapy in BD is depicted in [Figure 7]. […] It requires a combined effort of dermatologist, oncosurgeon, and plastic surgeon to plan and execute the management in various presentations of BD.

• #70 Bowen’s disease – treatment and symptoms | healthdirect

  https://www.healthdirect.gov.au/bowens-disease

  Bowen’s disease is a very early form of skin cancer. […] There are many ways to treat Bowen’s disease. […] Because it is such an early cancer, it can usually be cured. […] The best type of treatment for you will depend on: the size and thickness of the Bowen’s disease, where it is on your body, your age, your health in general. […] You can choose what treatment to have. […] Sometimes, Bowen’s disease comes back after treatment. It is important to go to follow-up appointments with your doctor or dermatologist. […] It’s very important to protect yourself from sun exposure to prevent skin cancers developing. […] You should also have your skin checked by a doctor at least once a year. […] If Bowen’s disease is not treated, a there is a chance it could become an invasive skin cancer called a squamous cell carcinoma. That means it can spread locally or to other parts of the body. […] You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.

• #71 Bowen’s disease

  https://www.pcds.org.uk/patient-info-leaflets/bowens-disease

  It is important to ask a healthcare professional for a full skin examination to check for other skin lesions that may also need attention. […] In terms of treatment, this depends on various factors including size site (where the Bowens disease is located), and your general health. […] Treatment options include: Efudix cream (5-FU cream) applied thinly once a day to the affected area and up to 4 mm of normal surrounding skin, usually for 4 weeks; occasionally your doctor may recommend longer. […] Cryosurgery this is the same cold spray (liquid nitrogen) used to treat warts. […] Photodynamic therapy this involves the combination of a cream with a special light source. […] Skin surgery given the usual good response to non-surgical treatments, the main indications for surgery are if the diagnosis is uncertain and/or the lesion is not responding to treatment. […] It is important that you discuss treatment options with your specialist (or GP) and ask about anything that you do not understand.

• #72 Spot Check | Bowen’s disease (squamous cell carcinoma in situ)

  https://spotcheck.clinic/conditions/skin-cancers/bowens/

  Bowen’s disease is usually easy to treat. Because it affects the surface layers of the skin, topical treatments are effective and may be preferred in cases where a good cosmetic outcome is desired, or surgery is inappropriate. […] Other treatments include excision, cryotherapy and photodynamic therapy. […] Regular check-ups will help detect new skin cancers. […] Check your skin regularly for signs of skin cancer. Be alert for “ugly duckling” spots that don’t resemble your other spots or moles. […] Due to a higher risk of skin cancers in future, including potentially serious squamous cell carcinomas, have a yearly full body skin check with an experienced skin cancer doctor. […] Even if you’ve already been diagnosed with skin cancer, it’s not too late to reduce your risk. Wear sunscreen whenever the UV index is over 3, cover up with long sleeves, sunglasses and a hat, and stay in shaded areas when possible.

• #73 Bowen’s disease – British Skin Foundation

  https://knowyourskin.britishskinfoundation.org.uk/condition/bowens-disease/

  Radiotherapy and laser are other therapies occasionally used for the treatment of SCC in situ. […] A particular problem with SCC in situ is that it frequently occurs on the lower legs. The skin on the lower legs is often tight and sometimes quite fragile, especially in older people. Healing in this area is slow. […] From now on, you should take precautions to prevent additional patches of squamous cell carcinoma in situ developing: […] Sun protection is recommended for all patients. It is advisable to protect the skin from further sun damage (for example, by wearing a hat, long sleeves and a sunscreen with a high sun protection factor). […] The British Association of Dermatologists recommend that you tell your doctor about any changes to a mole or patch of skin. […] Routine sun protection is rarely necessary in the UK for people of colour, particularly those with black or dark brown skin tones. However, there are important exceptions to this; for example, sun protection is important if you have a skin condition, such as photosensitivity, vitiligo or lupus, or if you have a high risk of skin cancer, especially if you are taking immunosuppressive treatments (including organ transplant recipients) or if you are genetically pre-disposed to skin cancer. […] The evidence relating to the health effects of serum vitamin D levels, exposure to sunlight and vitamin D intake, is inconclusive.

• #74 Interventions for cutaneous Bowen’s disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6464151/

  Overall, there has been very little good-quality research on treatments for Bowen’s disease. There is limited evidence from single studies to suggest MALPDT is an effective treatment. Although cosmetic outcomes appear favourable with PDT, five-year follow-up data are needed. Significantly more lesions cleared with MALPDT compared to cryotherapy. No significant difference in clearance was seen when MALPDT was compared with 5FU, but one study found a significant difference in clearance in favour of ALAPDT when compared to 5FU. There was no significant difference in clearance when cryotherapy was compared to 5FU. […] Specific recommendations cannot be made from these data, so this review cannot give firm conclusions about the comparative effectiveness of treatments. There is a clear need for future research to focus on a range of different studies comparing various therapies with each other, and in particular to surgical treatments to provide high-quality evidence to guide clinical practice. The age group, number and size of lesions, sites affected, and immunological status may all influence therapeutic choices. Longer-term follow up (up to 10 years) is needed to determine the effect of treatments on risk of progression of lesions of Bowen’s disease to squamous cell carcinoma.

• #75 Interventions for cutaneous Bowen’s disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6464151/

  Overall, there has been very little good-quality research on treatments for Bowen’s disease. There is limited evidence from single studies to suggest MALPDT is an effective treatment. Although cosmetic outcomes appear favourable with PDT, five-year follow-up data are needed. Significantly more lesions cleared with MALPDT compared to cryotherapy. No significant difference in clearance was seen when MALPDT was compared with 5FU, but one study found a significant difference in clearance in favour of ALAPDT when compared to 5FU. There was no significant difference in clearance when cryotherapy was compared to 5FU. […] Specific recommendations cannot be made from these data, so this review cannot give firm conclusions about the comparative effectiveness of treatments. There is a clear need for future research to focus on a range of different studies comparing various therapies with each other, and in particular to surgical treatments to provide high-quality evidence to guide clinical practice. The age group, number and size of lesions, sites affected, and immunological status may all influence therapeutic choices. Longer-term follow up (up to 10 years) is needed to determine the effect of treatments on risk of progression of lesions of Bowen’s disease to squamous cell carcinoma.

Zobacz więcej