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

Abstract

Pigmented Bowen's disease is a rare variant of in situ squamous skin cell carcinoma. It mainly affects patients between 60 and 70 years of age. Its clinical features include welldemarcated, pigmented plaque arising in photo-exposed areas of the body. The bestcharacterized feature of the disease by histological examination is the presence of atypical keratinocytes, hyperpigmentation of the epidermis with trans-epidermal elimination of melanin and dermal melanophages. Precise diagnosis is often difficult, both clinically and dermoscopically, as Bowen's disease is often mistaken with keratinocyte tumors such as solar lentigines, seborrheic keratosis, Bowenoid papulosis, pigmented basal cell

Identifying Pitfalls for Diagnosing Pigmented Bowen Disease on Reflectance Confocal Microscopy: Misleading Dendritic Cells

“…Thus, it is important to visualize DEJ in detail and follicular structures for signs of dendritic cell infiltration to rule out LM. Other clues for pBD are numerous marked small bright rings at DEJ [ 5 , 6 ]. Since DEJ is infiltrated by malignant melanocytes in LM, presence of regularly shaped bright rims can signify pigmented AK/pBD.…”

Bowen's Disease

“…They include 1) Classic BD - Atypical vascular pattern, whitish scale and a pinkish network; 2) Pigmented BD - pigmentation without structure, pigmented stripes and crusts; 3) Partially pigmented BD - Combination of above two. [ 87 ] The dermoscopic differential diagnoses are actinic keratosis, seborrheic keratosis, basal cell carcinoma, lichen planus-like keratosis, mammary Paget's disease, and lentigo malignant melanoma. [ 86 ]…”

“…The findings suggestive of pigmented BD are polygonal, refractile structures in upper layers, atypical honeycomb pattern, targetoid cells, different size and shaped atypical keratinocytes, and “button-hole signs” homogenous with tortuous blood vessels. [ 84 87 ]…”

Bowen's Disease: Literature Review

“…Высокое разрешение цифровой ультразвуковой визуализации позволяет изучить ткани без инвазии, а также использовать результаты для дальнейшего сравнения и определения прогрессирования болезни. Конфокальная лазерн ая сканирующая микроскопия также является неинвазивным методом передачи сканированных данных по состоянию слоев эпидермиса и дермы в очаге поражения [11,21]. Иммуногистохимический метод позволяет определить тип новообразования кожи, способность к инвазии и степень ее дифференцировки [22].…”