What criteria should I use to decide whether to refer a patient with Bowen's disease to a dermatologist?

Criteria for referral of a patient with Bowen's disease to a dermatologist:

• Consider referral if the lesion raises suspicion of squamous cell carcinoma, as Bowen's disease is an in situ squamous cell carcinoma and may require specialist assessment for diagnosis and management.
• Refer using a suspected cancer pathway if there is clinical concern about progression or if the lesion is large, symptomatic, or located in a site where delay could significantly impact outcome.
• Routine referral to dermatology is appropriate for lesions suspected to be basal cell carcinoma or Bowen's disease, especially if diagnosis is uncertain or treatment in primary care is not feasible.

In summary, patients with Bowen's disease should be referred routinely to dermatology for assessment and management, with urgent referral considered if there is suspicion of invasive squamous cell carcinoma or other high-risk features.

References: This approach aligns with NICE guidance on skin lesions suspicious for squamous cell carcinoma and basal cell carcinoma, recommending suspected cancer pathway referral for squamous cell carcinoma and routine referral for basal cell carcinoma, with consideration of urgency based on lesion characteristics ¹.