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

Abstract

Pigmented Bowen’s disease (pBD) is an uncommon in situ squamous cell carcinoma of the skin usually presenting as a dark scaly plaque involving chronically exposed sites, which is not uncommonly mistaken for other similar pigmented lesions, such as melanoma, pigmented basal cell carcinoma or seborrheic keratosis [1,2]. Dermoscopy has been proven to improve its diagnosis by showing several findings, i.e., gray/brownish dots in linear arrangement, scales, coiled vessels, focal/multifocal amorphous hypopigmentation and bluish structureless areas [1,2]. However, pBD may sometimes display dermoscopic features which are typical of other pigmented lesions, thus making its recognition quite troublesome despite the use of dermoscopy [1,2].We report a case of pBD with a “starburst” pattern, discussing its dermoscopic differential diagnosis.

Pigmented Bowen’s disease (Bowenoid Papulosis) dermoscopically mimicking melanoma

“…Presence of irregular brown dots, a structureless hypopigmented area in the lower pole, irregular radial streaks, abruptly terminated pigment network in the periphery, and multicomponent pattern and asymmetry (4%). Maione et al 2 reported a PBD which presented with starburst pattern. In our case, we neither detected polymorphic vascular pattern nor starburst pattern but only we detected irregular brown dots, a structureless hypopigmented area, irregular radial streaks, abruptly terminated pigment network in the periphery, multicomponent pattern and asymmetry.…”

When in doubt look up to the skies: A skywatchers perspective in dermatology

“…Can also be observed in pigmented Bowens disease and malignant melanoma. 31 The starburst giant cell refers to the multinucleated melanocytes with prominent dendritic processes seen in lentigo maligna melanoma. 32 Starburst hair follicles refer to the radially oriented, horizontally extending hair follicles seen in aplasia cutis congenita.…”

‘Red starburst’ pattern: a new dermoscopic indicator in discoid lupus erythematosus

“…The 'starburst' pattern was initially used to describe the dermoscopic hallmark feature of Spitz/Reed nevus. It is characterized by the presence of pigmented sharply focused streaks radially distributed at the periphery of a lesion, which correspond to confluent junctional melanocytic nests and histological radial growth [3].…”