Bowen's disease: an uncommon presentation

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A 60-year-old man presented with a lesion over the abdomen of 12–13 years' duration. The lesion had been gradually progressing over the years and was asymptomatic. It had been treated by application of 5-fluorouracil in 1993, which had resulted in partial regression; however, it started to grow again. A similar lesion had occurred over the left thigh, 2 years after the abdominal lesion appeared, and was excised. Past personal and family history was noncontributory. General and systemic examination revealed no abnormality. Dermatologic examination revealed a plaque, 18 cm × 15 cm in size, over the abdomen. It was well defined and erythematous. In places, hyperpigmented, verrucous, firm papules of various sizes were seen at the periphery and center of the lesion. There was no atrophy, ulceration, bleeding, and lymphadenopathy (Fig. 1). A differential diagnosis of hyperkeratotic lupus vulgaris, Bowen's disease, pagetoid type of basal cell carcinoma, squamous cell carcinoma, and superficial spreading melanoma was considered.Routine laboratory investigations were normal. Histopathology showed disease extending through the whole thickness of the epidermis. The basal cell layer was intact. Hyperkeratosis and acanthosis were present. Keratinocytes showed a loss of polarity and atypia. Individual keratinocytes were large, rounded, with pyknotic nuclei. Occasional horn pearls were seen. Keratinocytes with large hyperchromatic nuclei and multinucleated cells were present (Fig. 2). A diagnosis of “Bowen's disease” was made, the lesion was surgically excised, and skin grafting was performed.

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