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      The role of reflectance confocal microscopy in a case of Bowen’s disease difficult to diagnose

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          Abstract

          There have been limited reports describing reflectance confocal microscopy (RCM) features of Bowen’s disease (BD). Herein, we describe the RCM features of a pigmented BD with atypical dermoscopic features, mimicking a melanoma. This case highlights the importance of RCM in a challenging BD.

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          Pigmented Bowen's disease mimicking cutaneous melanoma: clinical and dermoscopic aspects.

          Daniela Massi, Paolo Carli, Alessandra Chiarugi … (2004)
          Pigmented Bowen's disease (BD) (squamous cell carcinoma in situ) has been rarely described among white patients. We report the case of a 48-year-old white male presenting a lesion of pigmented BD on his left thigh, clinically mimicking a superficial spreading melanoma. Naked-eye physical examination revealed a single 1.8 x 1.5 cm, hyperpigmented plaque with a rough surface, which appeared irregularly shaped and sharply demarcated. The assessment of this uncommon tumor by means of dermoscopy, never reported in literature before, was performed. According to standardized terminology, none among the well-established dermoscopic criteria useful to discriminate between melanocytic and nonmelanocytic origin was detected within the lesion. A reticular pigmentation simulated remnants of atypical pigment network, being of uncertain diagnostic value in the preoperative classification of the lesion. Other recognized patterns were irregular, brown globular structures and wide regression-like areas. None of the features diagnostic for pigmented basal cell carcinoma was found as well. The correct classification of nonmelanocytic origin of the lesion was therefore achieved only at histologic examination, after the complete surgical excision. In spite of its rarity, pigmented BD should be included among those lesions, which may simulate cutaneous melanoma. According to criteria validated by literature, dermoscopy failed to improve a preoperative classification of this peculiar skin tumor.
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            Reflectance confocal microscopy of Pigmented Bowen's disease: misleading dendritic cells.

            S Debarbieux, J L Perrot, E Cinotti … (2017)
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              Dermoscopy of Pigmented Bowen's Disease Mimicking Early Superficial Spreading Melanoma

              Yuka Hayashi, Masaru Tanaka, Reiko Suzaki … (2009)
              A 89-year-old Japanese woman presented at our clinic because of a several months’ history of an asymptomatic gradually enlarging pigmented skin lesion on the dorsum of the left foot. Physical examination revealed a single hyperpigmented oval macule of 5 mm with a rough surface. The color of the lesion was dark brown to light brown. Dermoscopic examination demonstrated atypical pigment network with small dotted vessels. Irregular streaks were also partially noted at the periphery. We suspected superficial spreading melanoma and performed an excision. The histologic features were consistent with a diagnosis of pigmented Bowen's disease. We could not completely account for dermoscopic aspects from the pathological findings of hematoxylin and eosin-stained specimens; therefore, specimens were stained with Fontana-Masson stain. It clearly demonstrated the distribution of melanin in the epidermis. We concluded that atypical network was due to an uneven melanin deposition in the variably thickened epidermal rete ridges.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Dermatol Pract Concept
                Journal ID (iso-abbrev): Dermatol Pract Concept
                Journal ID (publisher-id): DP
                Title: Dermatology Practical & Conceptual
                Publisher: Derm101.com
                ISSN (Electronic): 2160-9381
                Publication date Collection: January 2018
                Publication date (Electronic): 31 January 2018
                Volume: 8
                Issue: 1
                Pages: 63-65
                Affiliations
                [1 ]Department of Dermatology, Faculty of Medicine, University of Ege, Izmir, Turkey
                [2 ]Department of Pathology, Faculty of Medicine, University of Ege, Izmir, Turkey
                Author notes
                Corresponding author: Seda Yildiz, MD, Department of Dermatology, Faculty of Medicine, University of Ege, 35100, Bornova, Izmir, Turkey. Tel. +902323902698. Email: yildizsda@ 123456gmail.com

                All authors have contributed significantly to this publication.

                Article
                Publisher ID: dp0801a15
                DOI: 10.5826/dpc.0801a15
                PMC ID: 5808377
                PubMed ID: 29445580
                SO-VID: 8b0a8f1b-4a9c-4b3a-bc4a-2abfd31ffca3
                Copyright © ©2018 Karaarslan et al.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 15 June 2017
                Date accepted : 20 September 2017
                Categories
                Subject: Articles

                Keywords: bowen’s disease,reflectance confocal microscopy,melanoma
                Data availability:
                Keywords: bowen’s disease, reflectance confocal microscopy, melanoma

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