Dermatology: Practical and Conceptual Observation | Dermatol Pract Concept 2014;4(4):11 61 DERMATOLOGY PRACTICAL & CONCEPTUAL www.derm101.com Case report Case 1 A 54 year-old-man, presented with multiple, small, well- defined, gray-brown, papules and small papillomatous patches located on his penis, which had appeared over the last year (Figure 1). Genital warts, lichen planus, a verrucous nevus and BP were suspected among our clinical diagnosis. The dermoscopy revealed a pigmented papillomatous sur- face, brown-gray dots arranged in a linear distribution at the periphery of the lesion, and widespread dotted vessels (Fig- ures 2 and 3). A biopsy was done, and the histology showed mild hyperkeratosis, irregular acanthosis, dyskeratosis, cyto- logical atypia and mitosis (Figures 4 and 5), consistent with the diagnosis of BP. Dermoscopic findings in bowenoid papulosis: report of two cases Carolina Marcucci1, Emilia Cohen Sabban2, Paula Friedman1, Rosario Peralta1, Ignacio Calb3, Horacio Cabo4 1 Dermatologist, Buenos Aires, Argentina 2 Dermatology Section, Instituto de Investigaciones Médicas “A. Lanari”, University of Buenos Aires, Argentina 3 Dermatopathologist, Buenos Aires, Argentina 4 Dermatology Section, Instituto de Investigaciones Médicas “A. Lanari”, University of Buenos Aires, Argentina Keywords: dermoscopy, bowenoid papulosis Citation: Marcucci C, Sabban EC, Friedman P, Peralta R, Calb I, Cabo H. Dermoscopic findings in bowenoid papulosis: report of two cases. Dermatol Pract Concept. 2014;4(4):11. http://dx.doi.org/10.5826/dpc.0404a11 Received: June 19, 2014; Accepted: August 18, 2014; Published: October 31, 2014 Copyright: ©2014 Marcucci et al. 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. Funding: None. Competing interests: The authors have no conflicts of interest to disclose. All authors have contributed significantly to this publication. Corresponding author: Carolina Marcucci, M.D., 72 Ambrosetti St., Buenos Aires, Argentina. Tel. +0541149021487. Email: caromarcucci@hotmail.com Bowenoid papulosis (BP) corresponds to an in situ squamous cell carcinoma (SCC) located in the anogenital region. It is related to HPV, and presents with gray-brown elevated papules or plaques. A biopsy is needed to confirm the diagnosis; however, dermoscopy may be useful to differentiate this disease from other conditions, such as genital warts, seborrheic keratosis and lichen planus. In this paper we describe the dermoscopic findings in two patients with this disease. ABSTRACT Figure 1. Small gray-brown papules. (Copyright: ©2014 Marcucci et al.) 62 Observation | Dermatol Pract Concept 2014;4(4):11 Case 2 A 31-year-old male patient with no relevant medical history presented with gray-brown asymptomatic small papules on his penis that had appeared a few months before (Figure 6). The dermoscopy revealed multiple areas with grey-brown dots aligned in a linear fashion and a keratotic surface. No vascular pattern could be identified (Figure 7). A skin biopsy was conducted and the histological examination confirmed the presence of BP. Discussion BP represents a multifocal intraepithelial neoplasia located in the anogenital region [1]. The natural course of this disease is unpredictable: the lesions may increase, decrease, and even disappear spontaneously. Although progression to an invasive SCC is uncommon, it has been estimated in 2.6% of cases [2]. The most important differential diagnoses are genital warts, both clinically and dermoscopically [3]. Figures 2 and 3. Pigmented papillomatous surface. Linear arrangement of brown-grey dots, at the periphery of the lesion (black arrow) and widespread dotted vessels (white arrow). Original magnification x10. (Copyright: ©2014 Marcucci et al.) Figure 4. Mild hyperkeratosis, irregular acanthosis, dyskeratosis and mitosis (H&E X10). (Copyright: ©2014 Marcucci et al.) Figure 5. Cytological atypia, dyskeratosis and mitosis (H&E X40). (Copyright: ©2014 Marcucci et al.) Figure 6. Gray-brown asymptomatic small papules. (Copyright: ©2014 Marcucci et al.) To date and to our knowledge, no reports that specifically describe the dermoscopic findings of BP are available, and a few reports of dermoscopic examinations of this dermatosis Observation | Dermatol Pract Concept 2014;4(4):11 63 have been published in the literature. Dong et al. [3] reported two cases of BP showing an unspecific pattern, and one of the lesions also showed dotted vessels and a keratotic surface as in our first case. In a study describing pigmented lesions of the vulva, Ferrari et al. [4] also presented 2 cases of BP: one lesion revealed brown to gray structureless areas and glomerular vessels in a clustered and linear arrangement; the other lacked pigmentation and revealed multiple whitish-red exophytic papillary structures with central glomerular and hairpin vessels. The features of the two cases we presented were similar: brown-gray dots with a linear arrangement, located at the periphery of the lesion. These features remind us of pigmented Bowen’s disease, an in situ variant of cutaneous squamous cell carcinoma, which needs to be differentiated from BP at histopathological level [5,6]. Although more studies are needed to confirm these find- ings as criteria for BP, we think that in the presence of linear arrangement of brown-gray dots in a genital lesion, we should rule out BP among other diagnosis. References 1. Campione E, Centonze C, Diluvio L, et al. Bowenoid papulosis and invasive Bowen’s disease: a multidisciplinary approach. Acta Derm Venereol. 2013; 93:216–56. 2. Kutlubay Z, Engin B, Zara T, Tüzün Y. Anogenital malignancies and premalignancies: Facts and controversies. Clin Dermatol. 2013:31,362-73. 3. Dong H, Shu D, Campbell TM, et al. Dermoscopy of genital warts. J Am Acad Dermatol. 2011; 64:859-64. 4. Ferrari A, Zalaudek I, Argenziano G, et al. Dermoscopy of pig- mented lesions of the vulva: a retrospective morphological study. Dermatol 2011; 222:157-66. 5. Dirk M. Elston. The diagnosis: bowenoid papulosis. Cutis. 2010; 86:295-96. 6. Cameron A, Rosendahl C, Tschandl P, Riedl E, Kittler H. Derma- toscopy of pigmented Bowen’s disease. J Am Acad Dermatol. 2010; 62:597–604. Figure 7. Multiple gray dots aligned in a linear fashion (black arrow). Original magnification x10. (Copyright: ©2014 Marcucci et al.)