Development of poorly differentiated invasive squamous cell carcinoma in giant Bowen's disease: a case report with dermatoscopy

Abstract

Bowen's disease (BD) is an in situ form of squamous cell carcinoma (SCC), often occurring in the chronically UV-damaged skin of elderly people. The risk of progression of BD to invasive SCC varies between 3% and 5%, and one-third of invasive tumors may metastasize. Herein we discuss the dermatoscopic findings of a case of giant Bowen's disease, which progressed to poorly differentiated invasive SCC.

Keywords: Bowen’s disease squamous cell carcinoma; dermatoscopy; dermoscopy.

Figure 1.

Clinical image of the patient showed a 35×25 cm erythematous hyperkeratotic, crusted, and ulcerated plaque on the abdominal region. [Copyright: ©2016 Akay et al.]

Figure 2.

Dermatoscopy of the central region. (A) Linear arrangement of coiled vessels becoming convoluted and larger in size (blue arrows) intermingled with ulceration and adherent fibrin crusts. (B) White circles (blue arrows). [Copyright: ©2016 Akay et al.]

Figure 3.

Dermatoscopy the peripheral region. (A, B) White and pink structureless areas, white lines (green circle) and a linear arrangement of gray dots and coiled vessels (blue arrows). No ulceration or white circles are seen. [Copyright: ©2016 Akay et al.]

Figure 4.

(A) Histopathology of the peripheral part which is consistent with BD: An acanthotic epidermis shows full-thickness epidermal replacement by crowded keratinocytes that demonstrate disordered dyspolarity, lack of maturation, atypical mitotic figures and nuclear pleomorphism with hyperchromasia. A band-like lymphocytic infiltrate is apparent in the papillary dermis. (B) Histopathology of the central region shows invasive part of tumor which extends as invasive broad tongues into the dermis. This part of the tumor composed of pleomorphic atypical epithelioid cells with high nucleocytoplasmic ratio and frequent mitosis. Squamous differentiation features, such as squamous pearls or single cell keratinization, are not obvious. Foci of necrosis can be noted at the right part of the figure. [Copyright: ©2016 Akay et al.]