Relationship between dermoscopy and pathology in a case of clonal‐type pigmented Bowen's disease: Observation with vertical‐view dermoscopy

Abstract

Pigmented Bowen's disease (pBD) is a subtype of Bowen's disease, which presents clinically as a well‐circumscribed, hyperpigmented plaque. Its clinical manifestations are not fully characterized, and differential diagnoses include various pigmented skin lesions. Dermoscopy could be useful for the diagnosis, although nothing has been reported on the dermoscopic features of clonal‐type pBD. We herein report a first case of clonal‐type pBD on the sole and its dermoscopic features. Dermoscopy showed brown to blue‐gray dots/globules and focally anastomosing lines on the non‐weight‐bearing area, while the weight‐bearing area had a brown to blue‐gray fibrillar‐like pattern. To investigate the relationship between dermoscopy and histopathology, we focused on the melanin distribution in the horny layer of the epidermis, and used vertical dermoscopy observation. We investigated the relationship between dermoscopy and pathology by melanin depth estimation using a color lightness value.

Topical steroid application can induce branched/reticular vessels in Bowen disease on the upper trunk

“…Yang et al 11 considered that differences of their vascular findings from those of previous reports were probably because of their larger number of cases, a different percentage of pigmented and nonpigmented BD, or inclusion of Asian patients. Therefore, as a summary of previous reports, [4][5][6][7][8]10,11,16 vasculature other than glomerular blood vessels, such as linearirregular vessels and arborizing vessels, was not so rare. Meanwhile, there were no reports of reticular vessels or the effects of topical steroids on dermoscopy findings of BD.…”

“…The main dermoscopic features of typical BD are scaly surface, small brown glob- ules, structureless gray to brown pigmentation, and glomerular vessels distributed in clusters. 1,[4][5][6][7][8][9][10][11][12][13][14][15][16] On dermoscopy, glomerular vessels distributed in clusters are observed most frequently and are identified in 90% of the cases. 1,7 Dotted, linear-irregular, arborizing, polymorphic, and atypical vessels are less frequently observed in BD.…”

“…1,7 Dotted, linear-irregular, arborizing, polymorphic, and atypical vessels are less frequently observed in BD. 1,[4][5][6][7][8][9][10][11]16 However, the frequency of appearance of each blood vessel structure differs depending on the report as follows: glomerular vessels (44.2%-94%), dotted vessels (12%-64%), hairpin vessels (7.1%-42%), linear-irregular vessels (7.1%-42.5%), arborizing vessels (1.1%-14.3%), and polymorphic or atypical vessels (3.4%-8.1%). 1,[4][5][6][7][8]10,11,16 Among them, Yang et al 11 reported the highest number of BD cases (n=149).…”

“…1,[4][5][6][7][8][9][10][11]16 However, the frequency of appearance of each blood vessel structure differs depending on the report as follows: glomerular vessels (44.2%-94%), dotted vessels (12%-64%), hairpin vessels (7.1%-42%), linear-irregular vessels (7.1%-42.5%), arborizing vessels (1.1%-14.3%), and polymorphic or atypical vessels (3.4%-8.1%). 1,[4][5][6][7][8]10,11,16 Among them, Yang et al 11 reported the highest number of BD cases (n=149). Vascular structures were found in 129 (88.4%) patients; 101 (69.2%) lesions showed glomerular vessels, 62 (42.5%) lesions showed linear-irregular vessels, 26 (17.8%) lesions showed dotted vessels, 5 lesions (3.4%) showed polymorphous vessels, and 3 lesions (2.1%) showed arborizing vessels.…”

Dermoscopy of Bowen’s disease: A case series of five patients

“…The various terms used are irregular diffuse pigmentation, blotch, structureless brown and blue-gray pigmentation with keratosis, hyperkeratotic scaly area and verrucous structure. [6][7][8][9][10] We termed it as brown keratotic structureless area, as the area is structureless and keratotic and different from the brown homogenous area. Similarly, we used the term peppering, both fine and coarse [Figure 10], for pigmented structures that are not round or circumscribed and are different from dots and globules.…”