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For starters, our cancer insights share the NICE NG12 guidelines in quick, digestible updates. Referral pathways have never been clearer.

Featured image for Cancer Key article on Bowen's disease shows Squamous Cell Carcinoma on a forehead.
Published on 30th May 2023
All Cancer Keys

Bowen’s Disease: When Should We Refer?

Potential pitfall

Bowen's disease is an intra-epidermal squamous cell carcinoma (SCC) of the skin, otherwise known as a squamous cell carcinoma in situ. Left untreated, Bowen's disease may progress to invasive SCC; this may occur in as many as 16.3% of people with Bowen’s disease.

Helpful hint

If there are features suggestive of progression to invasive SCC, then patients should be referred to secondary care via an urgent suspected cancer pathway (2-week wait). Concerning features include:

  • Rapid growth
  • Pain or tenderness
  • Bleeding
  • Ulceration or induration
  • Surrounding inflammation
  • An elevated, raised, or thickened lesion
  • Lesions on the lips, genitals, perianal area or around the nails/digits

Be cautious in immunosuppressed patients, in particular post-transplant patients, who are at high risk of developing SCC that tend to metastasise quicker. Remember age (it usually affects patients in their 60s and 70s).

Seek advice and guidance if there is any diagnostic uncertainty.


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