There are a number of different treatments. Which treatment you have will depend on where the patch of Bowen’s disease is on your body, its size and thickness, and the number of patches there are.
How well the skin is likely to heal afterwards is an important factor when making decisions about treatment. For example, the skin on the lower legs tends to be more fragile, especially in older people. This means it may not heal as well, so certain treatments may not be suitable.
Bowen’s disease often grows very slowly, over a period of months or years. So, if you have a thin patch of affected skin that isn't changing, your dermatologist may advise you just keep checking it for changes. You may also have regular check-ups to monitor it carefully.
Observation can be a good option for people who are more likely to have problems with skin healing after treatment.
It may be possible to treat the area by freezing it. This is called cryotherapy or cryosurgery. Liquid nitrogen is sprayed onto the affected area. At the time, this feels very cold and a bit uncomfortable. Afterwards, you will have a scab, which usually falls off within a few weeks. This removes the affected skin.
Creams (topical therapy)
A chemotherapy cream called 5-fluorouracil (Efudix®) may be used. It’s also called 5FU. Chemotherapy is the use of anti-cancer drugs.
You put the cream onto the skin regularly over a period of time. It can make the skin in the area red and inflamed before the Bowen’s disease gets better. Usually there are no other side effects.
A cream called Imiquimod (Aldara®) can also be used. This works by using the immune system to attack the abnormal cells. You put it on the skin regularly over a period of time. It will cause some redness and skin irritation before the Bowen’s disease improves.
Curettage and electrocautery
Scraping away the affected area (curettage) and using heat or electricity to stop any bleeding (electrocautery) are suitable for small patches of Bowen’s disease. A local anaesthetic is given before the doctor scrapes away the area using a spoon-shaped instrument called a curette.
An electrically heated loop or needle is then used to stop the bleeding from the wound (cauterise it) and destroy any remaining abnormal cells. After this treatment, a scar may develop.
Photodynamic therapy (PDT)
Photodynamic therapy is a treatment that is used for different conditions. It can be a useful option for people with large areas of Bowen’s disease. It uses light combined with a light-sensitive drug (sometimes called a photosensitising agent) to destroy abnormal cells.
A photosensitising cream is put on the affected area. About 3–4 hours later, special light is shone onto the area for about 10–15 minutes. Afterwards, a dressing is put on to cover the area and protect it from light. Usually, more than one treatment is needed.
Surgery may be used for small areas of Bowen’s disease that can be removed under local anaesthetic. This is not always the best option for large patches of Bowen’s disease.
Laser treatment uses intense light energy to remove tissue. It's sometimes used as a treatment for Bowen's disease affecting the finger or genitals. Doctors are carrying out research trials to find out how effective this treatment is in the long term.