Volume 27, Issue 141, November 2023

A rare case of Bowen disease mimicking seborrheic keratosis

Aryan S Pal¹, Sandeep V Pal²

¹Student, Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
²Department of Dermatology, Skin, Hair, and Laser Clinic, Nagpur, Maharashtra, India

ABSTRACT

Bowen disease is well documented, but it is commonly misdiagnosed in clinical practice. Seborrheic keratosis appears very similar to Bowen's disease on cutaneous examination and is practically undifferentiable unless a biopsy is performed for histopathology. Pathologically, Bowen's disease is considered a squamous cell carcinoma in situ. At the same time, seborrheic keratosis shows keratin cysts and the presence of keratin-filled cysts with hyperkeratosis, acanthosis, hyperpigmentation, and inflammation also present. The lesions of Bowen disease usually present with good demarcation, are isolated and are observed with scaly plaques with an erythematous base. Pigmentation, fissures, and crusting of skin at the lesion's site may be rarely seen. Histopathologically, atypical keratinocytes are observed in the epidermis of the skin. The basement membrane is intact, and the disease cannot be termed squamous cell carcinoma yet. In the following case discussed, the lesion present on the patient was initially misdiagnosed as seborrheic keratosis. However, it recurred after some time, so a biopsy was performed, after which the diagnosis of Bowen's disease was made based on the histopathological report. Development of Bowen disease to squamous cell carcinoma is seen only in 3-5% of cases. Diagnosis can be made by performing a biopsy or by detecting fluorescence after the application of photosensitizers, indicating the presence of tumour cells. The effective treatment of the disease consists of cryotherapy, imiquimod cream and 5-fluorouracil, curettage, and cautery, which is a very common method, and photodynamic therapy (PDT), which is a recent form of treatment.

Keywords: benign tumor, seborrehic keratosis, bowen disease, skin lesion, histopathology

Medical Science, 2023, 27, e380ms3252

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DOI: https://doi.org/10.54905/disssi.v27i141.e380ms3252

Published: 18 November 2023