Warty and clear cell Bowen's disease

Abstract

A 54‐year‐old man presented with multiple lesions (seven) on the lower extremities and abdomen. These lesions had been present for at least 12 years with gradual growth and some had spontaneously disappeared; all were asymptomatic. Some of them had been treated with topical steroids and antimycotic creams with poor results. Past personal history was uneventful, but family history revealed the death of a son from metastatic visceral carcinoma.On dermatologic examination, six erythematous plaques of similar appearance were observed on the legs, abdomen and buttocks. All averaged 3 × 4 cm, with well‐defined but irregular borders that did not seem to be infiltrated. On the skin surface, thick scales and crusts were present. Areas of spontaneous involution with residual hypopigmentation were present. On the dorsum of the left foot the biggest lesion was observed, measuring 4 × 8 cm. Unlike other lesions this was verrucous in appearance, with peripheral inflammation (Fig. 1). No ulceration or regional lymphadenopathies were present. General physical examination was unremarkable.The warty lesion located at the ankleimageHistopathology revealed an intraepidermal carcinoma with an intact basal membrane, consistent with Bowen's disease. The presence of multiple clear cells was noted. The biopsy of the verrucous lesion showed an extreme thickening of the epithelium with the papilli reduced to very thin strands. The architectural features seemed to be fully disorganized. Numerous cells appeared highly atypical, with large, hyperchromatic nuclei. Multinucleated atypical cells were often present. Dyskeratotic cells with homogenous, strongly eosinophilic cytoplasm were numerous. The most distinctive feature was, however, the presence of multiple clear cells in the whole thickness of the epidermis. At some points there was effacement of the epidermal/dermal junction because of an intense chronic inflammatory reaction. Nevertheless, no atypicial cells were observed in the dermis (Fig. 2).Warty and clear cell Bowen's disease (Hematoxylin and Eosin, ×10)imageAll lesions were treated with cryosurgery except for the verrucous lesion, which was excised, and a full thickness skin graft was performed, whose donor site was the abdomen. The borders and bottom of the excised skin were free of tumor. The malignancy work‐up was negative.