A Case of Generalized Bowen's Disease Accompanied by Generalized Seborrheic Keratosis with Literature Review

Bowen's disease (BD) and seborrheic keratosis (SK) share certain common pathogenic factors, yet their relationship remains controversial. The central debate revolves around whether SK can undergo malignant transformation into BD or whether their coexistence merely represents a "collision tumor" phenomenon. This article aimed to explore the relationship, diagnosis, and treatment of BD and SK through a clinical case of generalized BD accompanied by generalized SK, supplemented with a review of relevant literature.

A 70-year-old male presented with a 14-year history of widespread "red patches" across his body. Dermoscopic examination of the red plaques revealed a red background with uniformly distributed glomerular vessels and scattered yellow-white scales. The brown plaques exhibited a homogeneous brown pattern with yellowish-white scales, occasionally accompanied by light red homogeneous structures and dotted or linear vessels. Histopathological analysis showed irregular epidermal hyperplasia, hyperkeratosis, parakeratosis, and acanthosis. The epidermal cells displayed disordered arrangement, significant atypia, and visible mitotic figures, while the basal cell layer remained intact. Inflammatory cell infiltration was observed in the dermis. The patient was diagnosed with generalized BD accompanied by generalized SK. Treatment included cryotherapy, oral acitretin capsules, and topical isotretinoin cream. The patient responded favorably to the treatment and continues to be monitored in follow-up.

Clinicians should maintain a high index of suspicion when evaluating irritated or inflamed SK lesions, as they may mask underlying Bowen's-like changes. Early recognition and appropriate management are essential to ensure optimal patient outcomes.