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 Dr Sampurna Roy MD

http://www.histopathology-india.net/dermpath.htm

Bowen's disease (squamous cell carcinoma in- situ) presents as scaly erythematous plaque on the  sun-exposed skin in elderly patients.

Etiological factors include prolonged exposure to solar radiation, ingestion of a chemical agents (arsenics) or HPV infection.
Histological appearances: Images1 ; Image2
-  There is full thickness dysplasia of the squamous  epithelum.
-  Pilosebaceous epithelium may be involved by atypical keratinoctes
-  Disorderly maturation of the epidermis.
- Overlying parakeratosis and loss of granular layer.
-  Mitotic figures, multinucleated cells and dyskeratotic cells are present.
- Stromal inflammation may be present in the dermis and occasionally features of regression is seen.
- Histological patterns include-  Psoriasiform pattern, atrophic form, verrucous hyperkeratotic type, irregular variant, pigmented type and pagetoid variant . Rarely mucinous and sebaceous metaplasia may be noted.

Differential diagnosis includes in-situ superficial spreading melanoma  and Extramammary Paget's disease.

Note, both in case of actinic keratosis and in Bowen's disease specific comment should be made on whether the nearest peripheral margins are free or involved.

Bowenoid papulosis noted in genitalia is histologically similar to squamous cell carcinoma in-situ. However,  features favouring the diagnosis of bowenoid papulosis  include  presence of numerous mitotic figures in metaphase, basophilic inclusions in the granular layer and koilocytes.
Erythroplasia of Queyrat represents squamous cell carcinoma in situ presenting on the mucous membranes of the glans penis,vulva and oral mucosa.   DermAtlas: Related link  ;  Bowenoid Papulosis-Image link  

Differential diagnosis: Bowenoid papulosis is a benign condition in contrast  to the malignant behaviour of Bowen's disease and Erythroplasia of Queyrat(EQ). Macroscopically bowenoid papulosis presents as  multiple small brown papules usually on the penile shaft. Bowen's disease and EQ are well defined erythematous plaques in a variety of sites . Bowenoid papulosis  and EQ are seen primarly in men . Bowen's disease occurs equally in men and women.

Visit: Virally induced Epidermal Lesions   ;    Actinic Keratosis .

Abstracts:

Bowen's Disease masquerading clinically as a follicular cyst in a renal transplant recipient.Am J Dermatopathol. 2007 Aug;29(4):412-3.

Detection of mucosal human papilloma virus DNA in bowenoid papulosis, Bowen's disease and squamous cell carcinoma of the skin.J Dermatol. 2006 May;33(5):331-7.

Invasive squamous cell carcinoma arising in refractory perianal Bowen's disease in a HIV-positive individual.Australas J Dermatol. 2006 May;47(2):120-3.

Intraepithelial sebaceous carcinoma of the eyelid misdiagnosed as Bowen's disease. J Cutan Pathol. 2006 Apr;33(4):303-8.

Bowen's disease involving the urethra.J Dermatol. 2005 Mar;32(3):210-3.

Premalignant and early squamous cell carcinoma.Clin Plast Surg. 2005 Apr;32(2): 223-35.

Human papillomavirus associated with Bowen's disease of the finger.J Dermatol. 2004 Nov;31(11):927-30.

Pigmented Bowen's disease mimicking cutaneous melanoma: clinical and dermoscopic aspects.Dermatol Surg. 2004 Apr;30(4 Pt 1):541-4

Bowen's disease of the nail.Dermatology. 2002;204(4):348-50.

Perianal Bowen's disease. Dis Colon Rectum. 1988 Jun;31(6):419-22.