Pigmented Bowen's disease associated with high-risk HPV simulating melanoma of the hand

Abstract

Bowen's disease is an in situ squamous cell carcinoma of the skin with only 2% of pigmented cases reported. It is clinically characterized by papules and plaques of blackened surface that may be caused either by sun damage - usually in photoexposed areas in elderly individuals - or by human papillomavirus infection - usually in the anogenital region of young adults. Dermoscopic aspects of Bowen's disease are discussed for over a decade, but with no definitive criteria that would lead to a definitive diagnosis. We present a case of Bowen's disease affecting the finger of a 57-year-old Asian patient. The lesion clinically and dermoscopically simulated a melanoma. Histopathological findings suggested the diagnosis of pigmented Bowen's disease. Pigmented Bowen's disease should be considered a differential diagnosis of melanoma, since its clinical and dermoscopic criteria are unspecific. Histopathological examination remains the gold standard for the diagnosis of the disease.

Pigmented Bowen’s disease on the proximal nail fold with extensive, parallel pigmented lines in dermoscopy

“…The pigmentation of pBD may be caused by cytokines from atypical keratinocytes which stimulate melanocytes. 3 Cases of pBD lesions that are smaller than 4 mm, as in our case, are rare 4 and, in such small lesions, it is difficult to distinguish pBD from other pigmented lesions by gross findings alone. Therefore, dermoscopy is critical for increasing the diagnostic accuracy of small pBD lesions.…”

The Impact of Human Papillomavirus Infection on Skin Cancer: A Population-Based Cohort Study

“…Alphapapillomaviruses were generally recognized as high‐risk HPV types, especially HPV 16, provoking anogenital, head, and neck cancers [22, 23]. A case report of pigmented Bowen's disease also confirmed the presence of high‐risk HPV types [24]. The association between high‐risk HPVs and skin cancers is elusive.…”

Dermoscopic examination of a case of pigmented intraepithelial carcinoma on the palm

“…There are very few reports on dermoscopic features of pigmented Bowen disease / intraepidermal carcinoma over acral skin. The various dermoscopic features are as follows: pigment network and glomerular vessels, 2 irregular network, radial streaming, peripheral globules and light brown to dark brown colouration and regression-like areas, 3 multicomponent pattern characterised by a central white-grey papillomatous area on an area of homogeneous red-brown pigmentation, regularly distributed dotted vessels, and a peripheral pigmented parallel furrow pattern, 4 Figure 1 Solitary asymmetrical well-defined polygonal plaque of variable thickness and crusting.…”

“…Classic bullous pemphigoid is a disease of the elderly, primarily affecting those over 70, while cases in our patient's age group (10-21) are the least common, 2 whilst drug-induced bullous pemphigoid typically affects a younger population. 1 Classical bullous pemphigoid is often difficult to manage, with a 11-23% mortality in the first year, 3 as opposed to drug-induced bullous pemphigoid which is controlled comparatively easily with a combination of topical and oral steroids and stopping the offending drug, with only a 0.4% mortality rate. 4 The difficulty in tapering steroids in this case is not atypical, as only 20.8% of cases of drug-induced bullous pemphigoid experience full recovery.…”