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Squamous cell carcinoma in-situ (Bowens Disease)

  • Bowen’s disease is a very early form of squamous cell carcinoma.
  • Usually appears as a slow-growing, red and scaly skin patch.
  • ‘In situ’ means the malignant cells are confined to cell of origin i.e., the epidermis. Over time the cells can invade into the dermis and then it is called an invasive squamous cell carcinoma.

The development of a lump or bleeding may indicate progression into invasive SCC.

Skin biopsies are often required to establish a diagnosis.

A biopsy is a simple procedure done at the time of the consultation.
Under local anaesthetic a small sample of the skin cancer is taken.
The sample is the sent to pathology for analysis.

Treatment options for Bowen’s disease

Efudix cream to treat Bowen’s disease (5 Fluorouracil)

Bowen’s disease (SCC in-situ) can be treated with Efudix cream.
Efudix cream is usually applied twice a day for 4 weeks.
During treatment the area will become red and crusted.
Efudix cream has a high cure rate and excellent cosmetic result
Treatment of Bowen’s disease with Efudix

Curette and Cautery

Under local anaesthetic the lesion is biopsied with a surgical blade, then scraped off with a curette (which is like a small spoon with very sharp edges) and then cauterized.
The treated area usually looks like a graze and takes 2-3 weeks to heal.
The wound can heal well with a flat scar which is often paler than the surrounding skin.
This treatment has a high cure rate for Bowen’s disease.

Aldara cream (Imiquimod)

Aldara is a treatment option for some Bowen’s disease.
The skin cancer must be biopsied before Aldara is used. This is to confirm the type of skin cancer and the depth. If the cancer is deep then Aldara is not a suitable option.
Aldara is applied by the patient once or twice a day for 10 weeks depending on a number of factors.
Aldara mobilizes your own immune system to attack the skin cancer cells.
The reaction to this cream is variable but most people experience some redness and crusting.
The cure rate with Aldara is approximately 80%.
The cost is not subsidized for Bowens disease, approximately $120.
The cosmetic result of a skin cancer treated with Aldara is usually better than a surgical scar.
Read more on the treatment of Bowen’s disease with Aldara

Surgical excision

Under local anaesthetic, the lesion is excised and sent to pathology for analysis.
The skin edges will then be sewn together to make a thin suture line.
There may be two layers of sutures (stitches) a layer underneath that is absorbable and a layer of sutures on the surface which will need to be removed in 7-14 days.
The excision is usually designed so that the resulting scar runs parallel with existing skin creases.
It is impossible to cut the skin without scarring in some way, so you will always have some sort of scar. Your dermatologist will try to excise the lesion in a way that will keep the scar to a minimum.
Some people have an abnormal response to skin healing and these people may get larger scars than usual (keloid or hypertrophic scarring).

Photodynamic Therapy (PDT)

PDT has a cure rate of approximately 80%.

Cream is applied to the lesion to be treated for approximately 3hours.
The cream is then activated by exposure to a specific wavelength of light for 10-20minutes.
Often the treatment is repeated 2-4 weeks later.

The advantage of PDT, compared to Aldara and Efudix, is that the red crusted stage is of shorter duration, one to three weeks, rather than three to six weeks.
The disadvantage of PDT is the expense, approximately $600 (compared to $50-$120 for Efudix and Aldara) and the treatment itself may be painful.

Find out more on PDT under our facilities


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Our expertise is in the early detection and treatment of skin cancer. On an average day any one of ... Read more
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What is a Dermatologist?

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Drummoyne Dermatology is a long established and well regarded dynamic dermatology centre which has provided state-of-the-art dermatology care in Sydney for over a decade. Our expertise is in the early detection and treatment of skin cancer and in the accurate diagnosis and optimal management of other diseases of the skin.
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