Pigmented Bowen's disease

Abstract

Pigmented Bowen's disease is rare, though more prevalent in men. It presents as a well-delineated plaque in areas unexposed to sun. There are reports of association with seborrheic keratosis, solar lentigo or exuberant pigmentation of genital and intertriginous regions. A specific dermoscopy finding is the presence of brown or gray dots in regular arrangement and coiled or dotted vessels. Thus, we aim to raise awareness of the diagnosis of pigmented Bowen's disease in pigmented lesions.

An unusual localised pigmented skin lesion on the nipple-areola complex

“…In pigmented seborrheic keratosis, hyperkeratosis and horn cysts are present, which are clearly demarcated from adjacent skin 2. In pigmented Bowen’s disease, histological examination shows hyperkeratosis, acanthosis, melanophages, and atypical keratinocytes with pigmented cytoplasm 3. Pigmented mammary Paget’s disease is characterised by the Paget cells, the large cytoplasm and mucin rich adenocarcinoma cells, as well as a large amount of melanin in the cytoplasm of tumour cells 4.…”

“…Pigmented seborrheic keratosis usually shows seborrheic and verrucous lesions with a well demarcated border 2. Pigmented Bowen's disease presents with a well defined black plaque with crusting or scaling surface, and the colour varying from brown to black 3. In pigmented mammary Paget’s disease, the lesion occurs on the NAC and surrounding skin.…”

Pigmented Bowen’s disease presenting with a “starburst” pattern

“…The detection of the “starburst” pattern in pBD might be due to the fusion of regularly distributed peripheral dots into streak-like projections, which therefore represent melanin pigment in the epidermis or horny layer [1–2]. Importantly, different from the aforementioned melanocytic lesions, the brownish streaks visible in pBD are less defined and appear out of focus and are associated with other features typical of Bowen’s disease [1–5], such as white scales, as seen in our patient.…”

“…Several studies/case reports have shown that pBD may present unusual/confusing dermoscopic findings [1–2], including peripheral streaks, which have been reported in four instances [1–5]. However, differently from our patient, the streak-like projections observed in the previous cases did not represent the main dermoscopic clue, as they were associated with other relevant findings (e.g., pigmented network, polychromatic areas, blue veil and/or brown dots in a regular arrangement), and were not regularly distributed at the periphery to configure a “starburst” appearance [1–7].…”

Reflectance Confocal Microscopy of Pigmented Bowen’s Disease: A Case Series of Difficult to Diagnose Lesions

“…This is a disease that is not always easy to distinguish from other skin diseases from a clinical and dermoscopic point of view. pBD can be easily confused with keratinocytic tumors such as solar lentigines, seborrheic keratosis, Bowenoid papulosis, pigmented basal cell carcinoma, pigmented actinic keratosis, as well as melanocytic lesions such as melanocytic nevus, pigmented epithelioid melanocytoma, and melanoma [2].…”