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Background: Patients with cutaneous malignant melanoma (CMM) are at increased risk of non-melanoma skin cancers (NMSCs) and possibly precancerous lesions., Objectives: To analyse the association between CMM and not only NMSCs but also precursor lesions, actinic keratosis (AK) and Bowen disease (BD)., Materials & Methods: The Finnish Cancer Registry data was used to calculate the age-standardized incidence ratio during 2000-2013 for basal (BCC) and squamous (SCC) cell carcinoma in patients with CMM. All tissue material collected from 70,420 subjects during 2000-2013 and reposited in the Biobank of Eastern Finland was used to calculate the age-standardized prevalence of BCC, SCC, BD and AK in CMM patients., Results: In both genders, the age-standardized incidence ratio of BCC and SCC was increased in CMM patients. The age-standardized prevalence of NMSCs and precursor lesions was higher in patients with CMM than in those without CMM, and was higher in CMM patients with immunosuppression (IS) than in those without IS. The association of M-Snomed subtypes, lentigo maligna (LM), melanoma in situ (MIS) and malignant melanoma (MM) with AK and/or BD was stronger than with BCC. LM revealed the highest association with the combination of AKBD-SCC. Male subjects showed a higher age-standardized prevalence of CMM, MM and BCC than females, but the opposite was observed for AK., Conclusion: Melanoma increases the risk of NMSCs, and IS may enhance this risk. Both malignant and in situ subtypes of melanoma associate with not only BCC and SCC, but also precancerous lesions.

Background: High-risk α-genus human papillomaviruses (α-HPVs) are linked to cervical and genital carcinomas; however, their correlation with cutaneous squamous cell carcinoma (cuSCC) or premalignant skin lesions remains controversial., Objective: We evaluated the contribution of high-risk α-HPV to the occurrence of cuSCC, Bowen's disease and actinic keratosis (AK), and the distribution of high-risk α-HPV genotypes in these cutaneous tumours., Methods: HPV genotypes were determined using a commercial PCR-based microarray on skin tissue samples collected from 76 [38 young (<60 years) and 38 elderly (>60 years)] cuSCC, 34 Bowen's disease, 48 AK patients and 10 young controls. Associations between α-HPV prevalence and relevant risk factors were analysed., Results: High-risk α-HPV was more frequently detected in cuSCC patients (57.9%) than in the patients with Bowen's disease (38.2%), AK (0.0%) and control patients (10.0%). The high-risk α-HPV prevalence was higher in young than in elderly cuSCC patients (65.8% vs. 50.0%, P = 0.031). The most common HPV type was 16, present in 90.9% of all HPV-carrying cuSCC patients. Multiple infections with different high-risk α-HPV types were found in 20.5% of HPV-related cuSCC, whereas only single infection with type 16 was found in Bowen's disease. Although sun exposure is known as a major risk factor for cuSCC, high-risk α-HPVs were more frequently found in non-exposed sites rather than in sun-exposed sites of cuSCC., Conclusion: Multiple infections, as well as single infection with high-risk α-HPV may link to cuSCC. In spite of the involvement of high-risk α-HPV at high levels in cuSCC and Bowen's disease, no high-risk α-HPV was detected in AK patients, suggesting that Bowen's disease rather than AK might be involved in the development of HPV-related cuSCC as a precursor., (© 2019 European Academy of Dermatology and Venereology.)

A 79-year-old Japanese woman presented with an ulcerated, brown-red nodule in the center of a sharply demarcated, tan-brown plaque situated on the left side of her right breast. Histologically, the plaque demonstrated an acanthosis with an intraepidermal epithelioma of Borst-Jadassohn. Small oval nests of bland-appearing basophilic cells in the periphery gradually enlarged into nests of various sizes and irregular shapes, composed of densely cohesive, atypical basophilic cells above the central nodule. The atypical keratinocytes shifted to atypical spindle cells beneath the acanthotic epidermis, penetrating deep into the subcutaneous tissue. In addition to vimentin and p63, the spindle cells were positive for several cytokeratin (CK) markers, including AE1/AE3, 34βE12 and CK5/6, which showed more intense signals closer to the epidermis. Basophilic cells in the clonal nests were positive for p63, AE1/AE3, 34βE12 and CK5/6. The MIB-1 index was estimated at approximately 40-50% in both the bland-appearing and the atypical basophilic cells. We describe the first case of spindle cell squamous cell carcinoma arising in an intraepidermal epithelioma expressed by clonal Bowen's disease, which was difficult to differentiate from clonal seborrheic keratosis., (© 2017 Japanese Dermatological Association.)

A 45-year-old farmer presented with ulcers and plaques over his scrotum for the past 4 to 5 years. The condition started as a small lesion on the shaft of the penis, which improved with treatment; however, after 2 to 3 months, papulonodular lesions developed on the scrotum, which increased in size and subsequently broke down to form ulcers. He denied drug abuse but had a history of multiple unprotected sexual exposures. He was prescribed oral antibiotics, which improved the lesions, but he failed to take the antibiotics for more than a week. He also used powders, lotions, and salves (exact nature not known), which did not help and sometimes even burned the skin. After stopping the medicine, he developed new lesions that followed a similar course. Examination revealed nontender ulcers on the scrotum with raised, rolled-out margins and pale red, granulation tissue that bled on touch (Figure 1). In addition, there were nodules with a pinkish red granular surface and scaly erythematous plaques on the scrotum. Regional lymph nodes were not enlarged.

Background: The role of human papillomaviruses (HPV) in the development of squamous cell carcinoma (SCC) has been established for anogenital lesions but still remains controversial for carcinomas in other sites. The aim of this study was to determine the α-HPV and β-HPV prevalence and their association with p16 expression, sun exposure, and clinicopathological findings in patients with Bowen's disease (BD)., Methods: One hundred sixty nine skin biopsy specimens from 157 immunocompetent patients with extragenital/extraungual BD were examined for HPV status and p16 expression. The presence of koilocyte-like changes, solar elastosis and papillomatosis was recorded for each specimen., Results: BD was diagnosed more often in potentially sun-exposed sites with prevalence 73.6 % and a remarkable predilection for the head and neck region. High risk α-HPV or β-HPV were detected in 34.7 % of lesions and β-HPV infections dominated over α-HPV. Higher prevalence of koilocyte-like changes and papillomatosis was found in HPV-positive specimens but it was not statistically significant. The expression of p16 was detected in 79.8 % of lesions and displayed no correlation with the HPV status. HPV-positivity tended to be detected more often in sun-protected sites. Dual infections by α-HPV/β-HPV genera and mixed α-HPV infections were not detected, while 37.5 % of β-HPV positive specimens were infected by two or more β-HPV genotypes. HPV 9 was significantly associated with mixed β-HPV infections., Conclusions: HPV may play an etiological role at least in some SCC in situ arising in extragenital sites. Sunprotected sites may be more dependent on HPV-mediated co-carcinogenesis than sun exposed areas. The presence of the p16-expression, papillomatosis or koilocyte-like change is not a reliable marker of HPV infection in SCC in situ.

Ingenol mebutate (IM) has recently been approved for the topical treatment of actinic keratoses. It appears to have a dual mechanism of action: rapid necrosis after gel application and a subsequent immune-mediated response, which targets any residual dysplastic epidermal cells. We report the successful treatment of a woman, who had been relapsing into Bowen's disease (BD) on her right forefinger for 8 years. During her clinical history, she had received an allogeneic, HLA-identical stem cell transplant for myeloproliferative syndrome with a JAK2V617F mutation and lobectomy of the pulmonary right lower lobe for adenocarcinoma. We used dermoscopy to monitor the therapeutic response of BD. We discuss IM gel as a possible therapeutic option for BD., (© 2016 S. Karger AG, Basel.)

Patients with HIV have higher risk of developing squamous cell carcinoma of the skin given the increased risk of HPV infection, which alters cell proliferation and apoptosis [1]. Pigmented Bowen's disease is an uncommon form of squamous cell carcinoma in-situ characterized by pigmented lesions that can clinically mimic superficial spreading melanoma, pigmented basal cell carcinoma, melanocytic nevus, Bowenoid papulosis, and seborrheic keratosis.

Coexisting variants of porokeratosis rarely occurs. Disseminated superficial porokeratosis (DSP) is characterized by multiple uniform small annular papules distributed all over body. DSP commonly coexist with linear porokeratosis (LP), but it is uncommon for DSP to coexist with porokeratosis of Mibelli (PM). PM presents with central atrophic erythematous plaques and thread-like elevated border. It occurs mainly on extremities. Although malignant transformation can be found in the porokeratosis, there is still no report case of coexisting variants of porokeratosis concurrent with Bowen's disease. The clinical and histopathologic finding of rare coexisting variants of porokeratosis (PM and DSP) concurrent with squamous dysplasia is described.

An unusual case of pigmented Bowen disease on the palm is presented.

The precursor protein of localized cutaneous amyloidosis (LCA) is believed to be cytokeratins on the basis of previous immunohistochemical studies. To identify the candidate amyloid protein biochemically, amyloid proteins were extracted with distilled water from lesional skin of LCA associated with Bowen's disease. The proteins were resolved on one- or two-dimensional polyacrylamide gel electrophoresis followed by characterization with immunoblot analysis. The proteins with multiple molecular weights of 50-67 kDa and two proteins with 25 and 35 kDa were identified as keratins, serum amyloid P component and apolipoprotein E, respectively. The unknown 14-kDa (pI = 7.0) and 42-kDa (pI = 5.4) proteins reacted with the antibody against galectin-7 and actin, respectively. The protein with the molecular weight of 14 kDa was identified as galectin-7 by MALDI-TOF mass spectrometer. Their electrophoretic mobilities were identical with normal counterparts extracted from cultured normal human keratinocytes. Galectin-7 and actin were detected by immunoblot assay in the water-soluble fractions prepared from the lesional skins of two patients with primary LCA. Immunohistochemical studies of tumor-associated (n = 9) and primary (n = 10) LCA revealed various degrees of positive immunoreactivities with the antibodies for galectin-7 and F-actin. Galectin-7 and actin, which contain considerable amount of β-sheet structure, may be candidate amyloidogenic proteins of primary and secondary LCA., (© 2013 John Wiley & Sons A/S.)

Background: In human immunodeficiency virus (HIV)-infected women, Bowen's disease may be difficult to treat successfully with surgery alone. Imiquimod cream, effective in treating Bowen's disease in healthy women, may be a useful postsurgical treatment in immunocompromised women., Cases: Two HIV-infected women had both Bowen's disease and severe cervical dysplasia. In both cases, Bowen's disease, but not cervical dysplasia, recurred after surgical treatment. When treated with topical 5% imiquimod cream twice weekly for 4 months, 70-80% reduction in lesions were observed in both patients. Follow-up biopsies of remaining lesions were vulvar intraepithelial neoplasia 1., Conclusion: Imiquimod cream, in combination with surgical treatment, may be an appropriate strategy for treatment of Bowen's disease in HIV-infected and other immunocompromised women.

Syringofibroadenoma is an extremely rare benign lesion with distinct histopathological features and variable clinical presentations. Most cases of syringofibroadenoma are thought to be benign skin appendage tumor with eccrine ductal differentiation, however, some syringofibroadenomas are suspected to be a reactive process. Herein, we report the first case of Bowen's disease accompanying syringofibroadenoma, which is suspected to be a reactive process, in a 78-year-old Japanese man. The precise nature of syringofibroadenoma accompanying carcinoma is still controversial. Syringofibroadenoma is thought to be a pre-existing neoplastic condition in some cases. In contrast, syringofibroadenoma is also considered to occur in a reactive process involving several inflammatory dermatoses and skin tumors, and the term "reactive syringofibroadenomatous hyperplasia" has been proposed. In this report, we summarize the clinicopathological features of carcinoma accompanying syringofibroadenoma and discuss the nature of syringofibroadenoma.

Background: Although bowel resections are commonly done for congenital malformations in children in developed countries, they usually follow neglected and preventable acquired diseases of the intestine in developing countries., Objectives: To determine the indications and outcome of bowel resections in children of a developing country in a university teaching hospital., Materials and Methods: Data of the patients operated (from birth to 15 years) was retrospectively collected over eight years (January 1999 to December 2006). The biodata of children included the following: Indications for operation, type of operations, duration of admission, and outcome of treatment including complications. Patients with Hirschsprung's disease were excluded from the study because bowel resection forms part of their definitive surgical management., Results: There were 70 patients (38 boys and 32 girls). The age ranged between four hours to 15 years (median, five months). There were 16 (22.9%) neonates, 26 (37.1%) infants, and 28 (40%) grown children. The indications were congenital anomalies in the 16 neonates. Also, 23 (88.5%) infants had intussusception, 2 (7.7%) had midgut vovulusm and 1 (3.8%) had congenital small intestine band. Among the grown children, typhoid ileal perforation (TIP) was seen in 14 (50.0%), intussusception in 5 (17.9%), and other causes in nine patients. Overall, intussusception was the most common indication for bowel resection, followed by TIP. A total of 24 patients developed 33 complications. Complications included wound infection in 47.8% and anastomotic leak in 42.8%. The duration of admission ranged between 4-35 days (median, 15 days). The overall mortality was 17.1% -; which was highest among neonates (56.3%), followed by the infants (26.9% -)., Conclusion: Bowel resections are mainly done for intussusception and complications of TIP at our centre. Late presentation, preexisting malnutrition, and nonavailability of parenteral nutrition contributed to unacceptable morbidity and mortality.

Background: Cutaneous Bowen's disease (CBD) is a form of intraepithelial squamous cell carcinoma that usually presents as a solitary lesion. We report four similar cases of a peculiar and well-delimited clinical subset of multiple Bowen's disease seen in the lower limbs in elderly women and associated with specific therapeutic problems., Observations: Four women aged over 70 years presented with multiple CBD limited to the lower limbs associated with squamous cell and superficial basal cell carcinomas along with actinic keratosis. No significant aetiological factors were present apart from chronic sun exposure other than one case possibly involving immunodeficiency. The four patients were treated using photodynamic therapy, and partial clinical response and good tolerance were observed., Discussion: These four cases share numerous clinical similarities: elderly women, markers of chronic sun exposure, lack of other aetiological factors such as arsenic or irradiation, localization of the lesions (multiple and/or continuous layer pattern, restricted to the lower limbs in all cases) and a chronic course. The frequency of this subset is probably underestimated due to absence of biopsies or to inconclusive histology reports. Photodynamic therapy yields valuable results with a good efficacy/safety ratio compared to imiquimod or 5-fluorouracil. However, while this treatment could be considered a first-line option in multiple CBD, its therapeutic value requires more detailed evaluation.

Epidermodysplasia verruciformis (EV) is a rare autosomal-recessive condition associated with a predisposition to infection with specific types of human papillomaviruses. A spectrum of wart-like lesions on the face, dorsa of the hands, and legs are characteristic clinical findings. Lesions usually develop in early childhood, persist, and may eventuate in cutaneous squamous cell carcinoma, usually in sun-exposed areas. These lesions are locally destructive and sometimes metastasize. We present a case of a 34-year-old African American woman with EV with a 9-month history of a right index finger ungual longitudinal pigmented band and nail splitting. Biopsy showed hyperkeratotic and parakeratotic subungual epithelium with verrucous hyperplasia. The superficial keratinocytes showed koilocytic changes. In addition, there was extensive, focally full-thickness keratinocyte dysmaturation with variable nuclear atypia and numerous mitotic figures, without apparent invasion. An associated melanocytic hyperplasia (confirmed by Melan-A stain), composed of large, pigment-laden dendritic melanocytes, was present without appreciable atypia or pagetoid spread. The findings are of a squamous cell carcinoma in situ arising in association with EV with incidental melanocytic hyperplasia. To the best of our knowledge, this is first report of a subungual presentation of this condition with associated melanonychia.

Bowen's disease is a form of squamous cell carcinoma in situ often associated with human papillomavirus (HPV). HPV has been hypothesized to cause in situ carcinoma via multiple mechanisms including cell immortalization and cell cycle disruption. Coinfection with HIV is associated with greater risk of malignancy. We describe a case of HPV-associated Bowen's disease in a 44-year-old African American male with sexually acquired HIV (CD4 < 20) who presented with an extensive skin lesion encompassing his penis, scrotum, and left inguinal canal.

Bowen's disease (BD) is a squamous cell carcinoma in situ characterized by a well-demarcated scaly erythematous thin plaque with an irregular outline. Clinically, BD is frequently misdiagnosed as superficial basal cell carcinoma, patches of dermatitis, psoriasis, lichen planus, actinic keratosis, benign lichenoid keratosis, irritated seborrheic keratosis, viral warts, amelanotic melanoma or melanoma. However, angiosarcoma has not usually been mentioned in the differential diagnosis of BD before. Herein, we describe two cases of BD presenting as purpura on the scalp of the elderly with an initial clinical suspicion of angiosarcoma.

Background: Haber's syndrome is a rare form of autosomal dominant genodermatosis. Clinically, it is associated with rosaceiform dermatosis of the face that begins in childhood, and profuse keratotic lesions resembling seborrheic keratoses, seen predominantly on the trunk, the tops of the limbs and the scalp. We report two cases of Bowen's disease and cutaneous epidermoid carcinoma in Haber's syndrome patients., Observations: A 67 year-old woman with Haber's syndrome and with a familial history consulted for a budding lesion on the abdomen, histological examination of which confirmed epidermoid carcinoma. A 77 year-old woman presented a clinical picture consistent with Haber's syndrome, with three infiltrated erythematosquamous abdominal lesions. Histological examination of a biopsy sample confirmed the clinical diagnosis of Bowen's disease. The patient was successfully treated with imiquimod., Discussion: These two cases appear to indicate the existence of an association between Haber's syndrome and the presence of cutaneous carcinomatous lesions. We propose the hypothesis of transformation of the keratoses seen in seborrheic keratosis. These lesions may be considered as pre-cancerous. Association with skin carcinomas requires regular monitoring of these patients. The use of imiquimod to treat lesions in patients with Bowen's disease resulted in complete cure.

A 54-year-old HIV-positive homosexual man presented with erythematous and pigmented plaques on background erythema in the perianal region, histologically consistent with Bowen's disease. Perianal Bowen's disease represents high-grade anal intraepithelial neoplasia, which is considered a precursor lesion of invasive anal squamous cell carcinoma. This patient's anal intraepithelial neoplasia was unresponsive to multiple treatment modalities including cryotherapy, serial curettage and cautery, topical 5-fluorouracil and 5-aminolaevulinic acid photodynamic therapy. He progressed to develop a poorly differentiated squamous cell carcinoma of the anus three and a half years after the Bowen's disease was diagnosed. The squamous cell carcinoma was treated with combined chemoradiation. A recurrence of high-grade anal intraepithelial neoplasia was noted 6 months after completion of chemoradiation.

Bowenoid papulosis (BP) is a condition triggered by human papillomavirus infection and characterized by the development of 1 or more warty lesions, usually in the anogenital region. Although the oral cavity has been known to host several types of warts, thus far only 4 cases of BP have been reported in this anatomic site. We describe a 42-year-old male with AIDS who presented with numerous papillary lesions of the labial mucosa and vermilion. Biopsy yielded a diagnosis of BP. Treatment of the condition consisted of intralesional and subcutaneous injections of interferon-alpha followed by topical application of imiquimod 5% cream. Neither regimen resulted in resolution of the lesions. To our knowledge, this represents the first case of BP arising in the oral mucosa of an HIV-infected individual.

Epidermodysplasia verruciformis (EV) is a very rare and chronic disease characterized by a susceptibility to cutaneous infections by a group of phylogenetically related human papillomavirus (HPV) types. We present here a 52-year-old man previously diagnosed and treated as squamous cell carcinoma but also found to have epidermodysplasia verruciformis lesions in association with Bowen's disease. The patient was effectively treated with a combination of interferon therapy (6 million units, twice a week) and topical imiquimod for Bowen's disease (five times a week). We conclude that topical imiquimod is very effective in the treatment of Bowen's disease and may be combined with systemic interferon therapy in rare cases with multiple vivid presentations of HPV infections.

We present a 79-year-old man who suffered from extramammary Paget's disease (EMPD) with bowenoid histological features accompanied by an ectopic EMPD lesion on his abdomen. He had had an erythematous plaque on his genital region for three years. Based on a biopsy specimen, he was referred to our hospital with the histological diagnosis of Bowen's disease. The histological findings of the genital lesion obtained by surgical resection showed typical areas of Paget's cells adjacent to areas characteristic of Bowen's disease. Immunohistochemical findings showed CEA and CK7 positive tumor cells in both areas, so the atypical cells showing the bowenoid pattern could be regarded as tumor cells of Paget's disease. Immunohistochemical staining for CEA and CK7 along with multiple biopsies can be helpful in making the diagnosis of Paget's disease with bowenoid histologic features.

We report here a case of Bowen's disease that developed in the periungual area of the left ring finger of a 55-year-old Japanese male. Because the histology of the lesion mimicked in part the features of a common wart, a PCR-based analysis of human papillomavirus (HPV) DNA and sequencing of viral DNA of PCR-amplified fragments were performed. The lesion contained HPV11 and 16 DNA, and HPV was suspected to play a role in the development of the lesion.

Purpose: Local excision is standard treatment for Bowen's disease, but controversy exists over the incidence of synchronous and metachronous cancers as well as the role of a preexcision mapping procedure., Methods: The medical records of 25 patients treated for perianal Bowen's disease between 1978 and 2001 were retrospectively reviewed., Results: There were 11 men and 14 women with a mean age at diagnosis of 47.9 +/- 14.9 years. The majority of patients (72 percent) had symptom-driven biopsies. Presentation included pruritus (56 percent), mass (28 percent), bleeding (24 percent), and anal pain (4 percent). The average duration of symptoms before diagnosis was 1.3 +/- 0.5 years. Two patients had microscopic disease discovered incidentally after hemorrhoidectomy and underwent no further treatment. Twenty-three patients underwent wide local excision, of which 19 (83 percent) had a formal mapping procedure. On final pathology, 23 patients (92 percent) had clear margins. There were three recurrences (mean time to recur 2.0 +/- 1.0 years), including the two patients who had positive margins after wide excision (1 after mapping) and one patient who had clear margins after mapping. Five patients (20 percent) had other carcinomas (1 sigmoid, 4 vulvar). At follow-up, 24 patients were alive with no evidence of Bowen's disease and 1 patient was dead secondary to sigmoid cancer with no evidence of Bowen's disease., Conclusions: Wide excision of perianal Bowen's disease results in excellent local control, although this is highly dependent on clear pathologic margins. A formal mapping procedure does not preclude recurrence. Initial screening and follow-up regimens are not uniform because of the wide range of treatment options available.

Multiple Bowen's disease may be difficult to differentiate from bowenoid papulosis because of its clinicopathological resemblance to bowenoid papulosis. We experienced a case of bilaterally and symmetrically developed multiple bowenoid lesions in a 71-year-old man previously diagnosed as having chronic lymphocytic lymphoma (CLL). Based on histological findings and the results of human papillomavirus examinations, we finally diagnosed this case as bilateral Bowen's disease. We speculate that the underlying immunosuppressive state due to CLL may have been associated with onset of the disease. We report the unique clinical picture, the differential diagnosis and the aetiology.

Topical imiquimod is an immune response modifier FDA approved for the treatment of anogenital warts. Recent studies have reported its effectiveness in the treatment of some types of basal cell carcinomas. There have also been some case reports and case series reporting success treating of squamous cell carcinoma in situ with imiquimod. We report two patients with squamous cell carcinoma in situ and one with invasive squamous cell carcinoma treated with 5% imiquimod cream. Lesions were located on shin, posterior shoulder, and nasal tip. 5% imiquimod cream was applied at night for six weeks. Side effects included erythema and crusting in one patient. Biopsies taken four weeks after treatment revealed no residual squamous cell carcinoma in situ or squamous cell carcinoma. Topical 5% imiquimod cream is becoming established as a promising treatment for squamous cell carcinoma in situ. It also seems to be an alternative treatment for some cases of squamous cell carcinoma.

A case of arsenical keratosis with multiple lesions of Bowen's disease and squamous cell carcinoma is described. The patient was successfully treated with a combination of acitretin and intralesional 5-fluorouracil. All the lesions resolved after three months of therapy with no side effects and no recurrence during four months of follow-up.

Perianal Bowen's disease is a uncommon, slow growing, intraepidermal squamous-cell carcinoma (carcinoma in situ) of the anal region and may be a precursor to squamous carcinoma of the anus. It is associated with cervical and vulvar intraepithelial neoplasia and have human papillomavirus as a common cause. Both sexes and all races are affected, with the highest prevalence in patients aged 20 to 45 years. The symptoms of anal Bowen's disease are unspecific and the clinical findings are uncharacteristic and include pain, itching, bleeding and a disturbing lump. Biopsy and histopathologic examination is required for diagnosis and to distinguish other perianal dermatoses; thus an anogenital warts that fail to respond to conventional therapy, or change in appearance, warrant a biopsy and, where the technique is available, DNA typing to identify the viral pathogen. Infact the etiologic agent, the human papillomavirus (HPV), has been classified by DNA techniques into at least 42 types, of which 16 and 18 are considered to carry a high risk for cancer. The intraoperative findings is a lesion at the anocutaneous line: perianal or intra-anal tumor, erosion or ulceration as well as lichenoid lesion or hyperpigmentation. The disease has a proclivity for recurrence and there are many controversies concerning treatment that effectiveness remains uncertain and range from aggressive wide local excision with skin grafting when necessary to laser vaporization (argon or CO2), radiotherapy or a new immune response modifier (Imiquimod). We report a case of a 50-years-old woman with recurrence of Bowen's disease associated with vulvar HPV infection and review the literature.

We report the successful use of topical imiquimod 5% cream for extensive multifocal, recurrent (post cryotherapy), biopsy-proven Bowen's disease of the nose. Treatment was applied on a once-a-day regimen, and a total of 32 applications over 9 weeks were used. A florid local skin reaction occurred early in the treatment, necessitating a rest period and decreasing the frequency of application. The Bowen's disease was coexistent with a multifocal superficial basal cell carcinoma (BCC) that had a partial response. Persistent BCC at 4 weeks post treatment was surgically excised. This tumour showed an unusual histological picture, with normal epidermis overlying residual BCC in the papillary dermis. The Bowen's disease remains clinically clear at 12-months follow up.