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Published on: August 18, 2022
Verrucous Variant of Bowen Disease
Zita Álvarez Bobillo1, Angel Fernandez-Flores2,3
1Department of Dermatology, Hospital Universitario Miguel Servet, Zaragoza, Spain.
The American Journal of Dermatopathology
|June 26, 2026
Summary
Verrucous Bowen's disease (BD), a rare variant of squamous cell carcinoma in situ, can mimic verrucous carcinoma. Immunohistochemistry, particularly p16 staining, is crucial for differentiating these conditions and identifying human papillomavirus (HPV) association.
Area of Science:
- Dermatopathology
- Oncology
- Virology
Background:
- Bowen's disease (BD), or squamous cell carcinoma in situ, is a common skin neoplasm with an unclear cause, often linked to human papillomavirus (HPV).
- Rare variants, such as verrucous BD, present diagnostic challenges due to their atypical appearance.
- The classic presentation of BD is an erythematous macule, but verrucous forms can resemble other lesions.
Purpose of the Study:
- To report a case of verrucous Bowen's disease.
- To emphasize the diagnostic challenges in differentiating verrucous BD from verrucous carcinoma.
- To highlight the utility of immunohistochemistry in this distinction.
Main Methods:
- Case presentation of a 91-year-old woman with a verrucous lesion on her leg.
- Clinical diagnosis suggested verrucous carcinoma, leading to surgical excision.
- Histopathological examination and immunohistochemical studies (p16, Ki67, p53) were performed.
Main Results:
- Histopathology revealed an exophytic verrucous tumor consistent with Bowen's disease, showing architectural disarray, atypia, and pagetoid spread.
- Immunohistochemistry showed strong, diffuse p16 and Ki67 positivity, with negative p53.
- These findings confirmed the diagnosis of verrucous Bowen's disease.
Conclusions:
- Verrucous BD is a rare subtype easily misdiagnosed as verrucous carcinoma.
- Accurate differentiation is critical due to the association of verrucous BD with high-risk HPV types.
- Immunohistochemistry, especially intense p16 expression, is vital for distinguishing verrucous BD from verrucous carcinoma.
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