Bowenoid papulosis with amyloid deposition.

Abstract

Sir, Localized cutaneous amyloidosis may be primary, as in lichen, macular and nodular amyloidosis, or secondary to a number of skin lesions, particularly tumours. The secondary form has most commonly been reported in association with various skin lesions of epithelial origin.1 We report a Korean man who had bowenoid papulosis (BP) with amyloid deposition on the penis and scrotum. A 69‐year‐old man presented with an 8‐month history of multiple painless penile and scrotal skin lesions. He denied any preceding penile eruption such as herpes simplex or condyloma acuminatum, but had a history of prostatic carcinoma and had undergone radical prostatectomy 2 years before. He had had no sexual contacts for a few years. Physical examination revealed multiple brownish papules and patches with erosions on the penis and scrotum (Fig. 1a). No cutaneous lesions were noted on other areas including the anal mucosa. Histopathology revealed mild hyperkeratosis, epidermal hyperplasia with keratinocytes showing various degrees of cellular atypia, loss of polarity, and atypical mitoses (Fig. 1b). The papillary dermis contained a mild perivascular lymphocytic inflammatory cell infiltrate, and amorphous deposits of an eosinophilic material that stained with Congo red (Fig. 1c). A histopathological diagnosis of BP with amyloid deposition was made. A limited surgical excision for polymerase chain reaction analysis with probes specific for the DNA of human papillomavirus (HPV) types 16 and 18 showed the presence of HPV‐16. The remaining lesions were treated with liquid nitrogen, but the patient returned 1 month later with new lesions, which were treated by wide excision. There has been no recurrence for 8 months of follow‐up.