Dermoscopic features of papillated Bowen’s disease

A 90-year-old female with controlled hypertension, presented with a 6-months history of an asymptomatic progressively growing pink lesion in the right thigh. There is no personal or family history of skin cancer. Clinical examination showed a 10 × 15 mm well-defined symmetrical erythematous tumor in the posterior region of the right thigh (Fig 1, A). Dermoscopy revealed a milky red honeycomb appearance with whitish septa separating whitish lacunae in the center and red lacunae on the periphery, some with glomerular vessels inside, with small continuous whitish structureless areas on the periphery (Fig 1, B). Complete surgical removal was performed. Histopathology revealed intraepidermal squamous cell carcinoma, clear cell papillomatous/papillated subtype (Fig 1, C and D).Key messageBowen's disease usually manifests as a slowly enlarging erythematous scaly patch or plaque.1Lee D.Y. Choi K.H. Park S.H. Lee J.Y. Yoon T.Y. Lobulated Bowen's disease with a clear cell change.Ann Dermatol. 2017; 29: 487-490Crossref PubMed Scopus (3) Google Scholar An uncommon variant of Bowen's disease showing a verrucous appearance with a prominent clear cell change on histopathology was recently reported in 2017.1Lee D.Y. Choi K.H. Park S.H. Lee J.Y. Yoon T.Y. Lobulated Bowen's disease with a clear cell change.Ann Dermatol. 2017; 29: 487-490Crossref PubMed Scopus (3) Google ScholarGiven the rarity of this presentation, the differential diagnosis should include pagetoid Bowen's disease, extramammary Paget's disease, clear cell acanthoma, superficial spreading melanoma, sebaceous carcinoma, and trichilemmal carcinoma.1Lee D.Y. Choi K.H. Park S.H. Lee J.Y. Yoon T.Y. Lobulated Bowen's disease with a clear cell change.Ann Dermatol. 2017; 29: 487-490Crossref PubMed Scopus (3) Google ScholarDetailed descriptions of its dermoscopic features have been quite limited.2Namiki T. Ichiyama S. Funasaka Y. et al.Dermoscopy of pigmented papillated Bowen disease: a report of two cases.J Dermatol. 2017; 44: e23-e24Crossref PubMed Scopus (4) Google Scholar There may be some difficulty recognizing the characteristic vascular structures and surface scales of conventional Bowen's disease.2Namiki T. Ichiyama S. Funasaka Y. et al.Dermoscopy of pigmented papillated Bowen disease: a report of two cases.J Dermatol. 2017; 44: e23-e24Crossref PubMed Scopus (4) Google Scholar We propose a new dermoscopy feature called "milky red honeycomb": whitish septa separating whitish lacunae in the center, red lacunae on the periphery with some glomerular vessels inside, and small continuous whitish structureless areas on the periphery. Bowen's disease usually manifests as a slowly enlarging erythematous scaly patch or plaque.1Lee D.Y. Choi K.H. Park S.H. Lee J.Y. Yoon T.Y. Lobulated Bowen's disease with a clear cell change.Ann Dermatol. 2017; 29: 487-490Crossref PubMed Scopus (3) Google Scholar An uncommon variant of Bowen's disease showing a verrucous appearance with a prominent clear cell change on histopathology was recently reported in 2017.1Lee D.Y. Choi K.H. Park S.H. Lee J.Y. Yoon T.Y. Lobulated Bowen's disease with a clear cell change.Ann Dermatol. 2017; 29: 487-490Crossref PubMed Scopus (3) Google Scholar Given the rarity of this presentation, the differential diagnosis should include pagetoid Bowen's disease, extramammary Paget's disease, clear cell acanthoma, superficial spreading melanoma, sebaceous carcinoma, and trichilemmal carcinoma.1Lee D.Y. Choi K.H. Park S.H. Lee J.Y. Yoon T.Y. Lobulated Bowen's disease with a clear cell change.Ann Dermatol. 2017; 29: 487-490Crossref PubMed Scopus (3) Google Scholar Detailed descriptions of its dermoscopic features have been quite limited.2Namiki T. Ichiyama S. Funasaka Y. et al.Dermoscopy of pigmented papillated Bowen disease: a report of two cases.J Dermatol. 2017; 44: e23-e24Crossref PubMed Scopus (4) Google Scholar There may be some difficulty recognizing the characteristic vascular structures and surface scales of conventional Bowen's disease.2Namiki T. Ichiyama S. Funasaka Y. et al.Dermoscopy of pigmented papillated Bowen disease: a report of two cases.J Dermatol. 2017; 44: e23-e24Crossref PubMed Scopus (4) Google Scholar We propose a new dermoscopy feature called "milky red honeycomb": whitish septa separating whitish lacunae in the center, red lacunae on the periphery with some glomerular vessels inside, and small continuous whitish structureless areas on the periphery. None disclosed.