A Case of Pigmented Bowen's Disease

Department of Dermatology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
Annals of Dermatology (Impact Factor: 1.39). 05/2009; 21(2):197-9. DOI: 10.5021/ad.2009.21.2.197
Source: PubMed


Pigmented Bowen's disease is characterized by increased melanin pigment in the epidermis or papillary dermis, in addition to the typical findings of Bowen's disease. This disorder has been infrequently reported and it represents less than 2% of all cases of Bowen's disease. Thus far, there has been only 1 case of pigmented Bowen's disease on the umbilicus in the medical literature, and no such case has been reported in Korea. Pigmented Bowen's disease develops on sun-exposed areas of the face and neck, as well as sun-unexposed areas like the trunk, extremities, perianal area and umbilcus. A 36-year-old man presented with a 9-month history of solitary dark brown slithery or wavy plaque with a verrucous surface on the umbilicus, and the lesion measured 1 x 2 cm in size. The histopathologic findings showed hyperkeratosis, parakeratosis and atypical keratinocytes disorderly arranged throughout the epidermis. Increased melanin pigment was noted in the basal layer of the epidermis. From these findings, we diagnosed this lesion as pigmented Bowen's disease.

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    • "It has been suggested that neoplastic cells may produce specific factors or cytokines that induce proliferation of melanocytes and stimulate melanin synthesis [20]. Satter proposed that the pigmentation is due to the presence of an increased number of enlarged melanocytes with hypertrophic dendritic processes dispersed throughout the neoplasm [26]. "
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    ABSTRACT: Bowens' disease (BD) is a precancerous condition of skin and/or mucosa with a predilection towards sun-exposed areas. Extensive literature research failed to reveal any case of multiple pigmented BD in type V Fitzpatrick skin. Multiple BD is a therapeutic challenge with a tendency to recur. Here we present an otherwise healthy Indian male having multiple pigmented lesions of BD on sun-protected sites of the body mimicking malignant melanoma. These lesions were refractory to treatment with different modalities. This paper is an attempt to review the available literature regarding the pigmented variant of multiple BD. Rationale for a therapeutic trial of UVB therapy for multiple arsenic induced BD is also discussed.
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    ABSTRACT: Pigmented Bowen disease (PBD) is a rare tumor characterized by increased melanin pigment in the epidermis or papillary dermis in addition to the typical findings of Bowen disease. We report the case of a 60-year-old woman who presented with a 6-month history of a gradually enlarging solitary dark brown plaque in her right inguinal region. Histopathology showed hyperkeratosis with parakeratosis, acanthosis, disorganization of epidermal architecture, atypical keratinocytes, and increased melanin pigment of the papillary dermis. Considering the clinical and the histological evidence, a diagnosis of PBD was established. Complete resection confirmed the diagnosis. Pigmented Bowen disease is an unusual form of squamous carcinoma in situ. Other tumors in the differential diagnosis include pigmented basal cell carcinoma and superficial spreading melanoma.
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