Bowen's disease (BD) is an epidermal in-situ squamous cell carcinoma (SCC). Most Human Papilloma Viruses (HPV)-positive lesions in Bowen's disease are localized to the genital region or distal extremities (periungual sites) in which HPV type-16 is frequently detected. Patient was a 64-year-old construction worker for whom we detected 2 erythematous psoriasiform reticular scaly plaques on peri-umbilical and medial knee. Biopsy established the diagnosis of Bowen's disease and polymerase chain reaction assay showed HPV-6, -18 co-infection. Patient was referred for surgical excision.

Bowen’s disease is a form of intraepidermal squamous cell carcinoma (SCC) characterised by a persistent, non-elevated, red, scaly or crusted plaque with a small potential for invasive malignancy. Most cases of typical Bowen’s disease in the white population are found on the lower legs of the elderly women. However, in this part of the world, i.e. Kashmir, the most common site is thighs followed by the lower abdomen. A range of treatment options are available for it including cryotherapy, curettage and cautery, photodynamic therapy, laser destruction, surgical excision, 5-fluorouracil cream, imiquimod cream, and radiotherapy. The aim of this study was to evaluate the efficacy of surgical excision in Bowen’s disease. All the patients with biopsy proven Bowen’s disease were included for the study. A detailed history was taken for each patient including the history of medical treatment for Bowen’s disease. Wide surgical excision (including either fusiform excision, W-plasty, or Z-plasty) was performed in each patient and the patients were then followed up for any recurrence. No sign of renewed disease activity at 6 months follow-up was taken as cure. All patients are intended to be followed up for 5 years. Ten out of 12 patients reported the use of topical imiquimod cream but complained of the progression of lesions. Surgical excision was performed in 12 patients. All the patients are currently under regular follow-up. Except for secondary infection and wound dehiscence in one patient, all the patients are in good condition with no signs of recurrence. Although it was a preliminary study, we recommend surgical excision in treatment of Bowen’s disease due to low recurrence rate.

Pigmented Bowens disease is an in situ squamous cell carcinoma, which is seldom reported in white patients. Herein we report a 20-year-old woman with type III skin, who had this lesion on the fourth finger of her right hand, similar to superficial malignant melanoma, clinically. Although dermoscopic evaluation could be helpful, correct diagnosis of non-melanotic origin is done by histological examination. In spite of its rarity, pigmented Bowens disease should be considered in the differential diagnosis of malignant melanoma.

Pigmented Bowen''s disease is an uncommon in situ squamous cell carcinoma of the skin, which has been rarely reported on the finger. Herein, we report an unusual case of pigmented Bowen''s disease of the pulp of the fourth finger in a 20-year-old white woman, which was clinically presented as a superficial, spreading malignant melanoma. Physical examination revealed a solitary hyperpigmented patch, measuring 1 cm in its greatest diameter. The lesion had an irregular, but well-defined margin, and was homogeneously brown with a smooth surface. There was no nodularity or induration in the lesion or in its surrounding skin. A skin biopsy was obtained with the clinical suspicion of malignant melanoma. Histological examination was compatible with the diagnosis of pigmented Bowen’s disease. Surgical treatment was then considered and the patient underwent complete excision of the lesion. In spite of its rarity, Bowen’s disease should be considered in the differential diagnosis of pigmented lesions, particularly malignant melanoma.

Seborrheic keratosis is a common, benign skin tumor. Numerous reports have shown its possibility of malignant transformation. This study was designed to demonstrate the occurrence of concomitant seborrheic keratosis and skin cancers. Data was retrospectively reviewed from all patients with a diagnosis of seborrheic keratosis in pathology department of Alzahra Hospital and a private pathology laboratory in Isfahan, Iran over a 4-year period. We classified all demographic data and associated dysplasia or Bowen's disease and analyzed them by student-t or chi-square tests. From all 429 specimens, 5 (1.2%) were found to be associated with Bowen's disease and one (0.2%) with mild dysplasia in squamous epithelium. All cases arose within the clinically, atypical seborrheic keratosis. More men were affected with lesions alone and with malignancy (230/423 (54.4%) and 5/6 (83.3%), respectively) compared to women. The average age of patients suffering from lesions with and without associated malignancy was 57 and 54 years, respectively. The common site of lesion alone was head and neck but lesions with malignancy involved lower extremities. The two lesions were significantly different in site of occurrence (p < 0.001). Generally, although the association between seborrheic keratosis and skin malignancy appears to be accidental, it must always be in mind. Therefore, histopathologic examination of all seborrheic keratosis should be considered, especially when seborrheic keratosis has atypical clinical manifestations.

A 47-year-old man with 3 years history of a pruritic plaque, 1×3 cm on his left leg attended a dermatology clinic. An incisional biopsy was done with the differential diagnoses of: 1) Hypertrophic lichen planus, 2) Lichen simplex chronicus, 3) Psoriasis, 4) Bowen's disease. A diagnosis of “Fibroepithelioma” was suggested by histopathologist who was not compatible with clinical diagnosis. Careful review of slide showed that the specimen had been cut horizontally in the laboratory, which had misled the pathologist. By vertical sectioning the block and doing another biopsy, the diagnosis of hypertrophic lichen planus was confirmed. The patient was treated with intralesional triamcinolone injection and 4 weeks later the lesion was completely healed with residual hyperpigmentation.

What is the boundary between in situ lesion and invasive ones. Some times it is difficult to answer this question histologically. In this study we evaluated the expression of P27, Ki-67 and P53 markers in squamous cell carcinoma (SCC), actinic keratosis (AK) and Bowen disease (BD). In this study 60 skin biopsies samples were examined by immunohistochemical staining for detection of Ki-67, P27 and P53. From total number of 60 patients, 15 patients had SCC, 15 patients had BD and remaining 15 had AK. We should be note that 15 specimens were taken from normal skins of patient who undervent mamoplasty surgery. Ki-67 index was positive in 0.8%, 23.7%, 12.3% and 19.3% percent of normal skin, AK, BD and SCC specimens, respectively. Accordingly, the percentage of Ki-67 possivity was significantly lower in normal skin compared with other pathologic conditions. P27 was positive in 23.4%, 26.2%, 25.9% and 4.5% percent of skin specimens in normal, AK, BD and SCC groups, respectively. The percentage of Ki-67+ cells was significantly lower in SCC group comparing with BD and AK groups. P53 index was positive in 26.6, 41.8 and 54.6 percent of patients with AK, BD and SCC, respectively. We didn’t observe any P53 possivity in normal skin specimens and its highest possivity was observed in SCC patients. Based on our results, quantitative and qualitative evaluation of Ki-67, P27 and P53 expression may be helpful for differentiating malignant from nonmalignant epidermal lesions.

Cutaneous malignancies are common in dermatologic practice. Due to their relation to sun exposure the characteristics of these malignancies can differ in various geographic locations. This study intends to determine the characteristics of surgically treated cutaneous malignancies and various surgical modalities that have been applied. This was a retrospective study of patients with cutaneous malignancies who underwent surgery over a six-year period. Data regarding the general information, type of malignancy, location, surgical margin involvement and specific surgical modalities were recorded and analyzed.A total of 432 patients were included. Basal cell carcinoma was the most common malignancy (82.8%) followed by squamous cell carcinoma (13.4%). Lentigo maligna, keratoacanthoma, basosquamous carcinoma, sebaceous carcinoma and Bowen’s disease accounted for the minority of cases. Patient's mean age was 65.7 years and the most common location was the nose and cheeks. The mean diameter was 2.97 cm. Excision was performed with safe margins. Incomplete excision was seen in 14% of basal cell and 15% of squamous cell carcinoma cases. The most common type of defect closure was a simple closure (43.9%). Basal cell carcinoma is the most common type of cutaneous malignancy. Surgery yields a satisfactory response as treatment for this cutaneous malignancy.

Bowen’s disease (BD) is a non-melanoma skin cancer with several histological subtypes. Herein we describe a case of a 35-year-old woman with a 4-cm diameter crusted plaque on the parietal scalp region. She had the lesion for 2 years. It had previously been histologically diagnosed as pemphigus vulgaris and only treated with a topical cream. The lesion progressively became thicker and larger. A new biopsy showed atypical cell proliferation through the whole thickness of the epidermis and follicular epithelium, with dermal microinvasion along with acantholysis and clear cell formation. The patient underwent total lesion excision (1 cm margin) with the diagnosis of both acantholytic and pagetoid subtypes of BD and dermal microinvasion. We describe a rare case of a young female patient with both subtypes of BD present in one lesion on an area not exposed to the sunlight. The lesion was initially misdiagnosed as pemphigus vulgaris.

Bowen’s disease (BD) is an in situ squamous cell carcinoma ofthe skin. Pigmented Bowen’s disease (pBD) is a rare variant,representing less than 2% of all BD cases. We report a case ofGiant pBD arising from seborrheic keratosis in a 65-year-old man.The dermoscopy showed a scaly surface, structureless brown togrey-black areas with dotted vessels, glomerular and reticulatevessels, and a few brown globules. Histopathology was classicalwith a “windblown appearance”; prominent melanophages wereseen in the dermis. Owing to the size and thickness of the plaque,a wide excision with a split-skin graft was done. The graft uptakewas good, and the patient was followed up on days 4 and 26post-surgery. We present our experience with the diagnosis andmanagement of this rare case of giant pBD. To the best of ourknowledge, such a case has not been previously reported.