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5 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
Bowen's disease is the earliest form of squamous cell skin cancer: abnormal cells fill the outer layer of the skin but have not broken through it, so it cannot spread. It looks like a red, scaly patch, often on the lower leg, and it is usually cured by a cream, freezing, light treatment or a small operation.
What it is. Bowen's disease is squamous cell carcinoma in situ of the skin. The keratinocytes of the epidermis have become malignant across its full thickness, but the basement membrane beneath them is intact, so there is nothing for the cancer to spread through: no blood vessels and no lymphatics reach into the epidermis. Cancer Research UK describes it as pre-invasive and as a very early form of non-melanoma skin cancer that grows very slowly. In the staging system UK reports use it is the pTis category, which is stage 0.
How it differs from its parent. Invasive cutaneous squamous cell carcinoma has broken through the basement membrane into the dermis and can therefore reach lymph nodes; Bowen's disease has not and cannot. That single structural difference is the whole of the difference in outlook, and it is why the treatments are different: a lesion that cannot spread can be treated with something that destroys the epidermis, such as a cream, cryotherapy or photodynamic therapy, where an invasive cancer needs the tissue beneath it removed and examined. It differs from actinic keratosis in the other direction: an actinic keratosis is dysplasia in sun-damaged skin and is not a neoplasm at all in ICD-10, while Bowen's disease is a carcinoma, coded in the neoplasm chapter.
| Setting | Approach | Guideline |
|---|---|---|
| Typical lesion | Topical fluorouracil or imiquimod, cryotherapy, curettage and cautery, photodynamic therapy, surgical excision, Mohs surgery, radiotherapy or laser; Cancer Research UK states that all of these can work well and that cure rates are high. The choice is driven by the site, the size, how well the skin there heals and what the person can manage at home. The treatment layer of this family carries the detail. | not mapped |
| If invasion is found | The diagnosis becomes invasive cutaneous squamous cell carcinoma and is managed on that pathway, with the adjacent Bowen's disease itself usually counted as a high-risk feature of the invasive tumour (RCPath G124). See the cutaneous squamous cell carcinoma page. | not mapped |