Collision tumor: pigmented Bowen's disease and seborrheic keratosis

Bowen's disease is a type of squamous cell carcinoma in situ of the skin. The pigmented form is rare and represents less than 2% of cases. We report a case of a 74-year-old black man with a blackened and asymptomatic leg injury for about 6 months. Clinically, and under dermatoscopy, the injury was suggestive of melanoma or melanoacanthoma, and a definitive diagnosis was made by histopathological examination.

Keywords:
Bowen's disease; Melanoma; Keratosis, seborrheic

Authorship

Karen de Almeida Pinto Fernandes Mailing Address: Karen de Almeida Pinto Fernandes. E-mail: karenfernandes22gf@hotmail.com

Oncological Dermatology Service, Instituto Nacional do Câncer, Rio de Janeiro (RJ), Brazil.Instituto Nacional do CâncerBrazilRio de Janeiro, RJ, BrazilOncological Dermatology Service, Instituto Nacional do Câncer, Rio de Janeiro (RJ), Brazil.

https://orcid.org/0000-0002-2689-8248

Diana Carolina Salamanca Martinez

https://orcid.org/0000-0001-9058-2136

Aretha Brito Nobre

Division of Pathology, Instituto Nacional do Câncer, Rio de Janeiro (RJ), Brazil.Instituto Nacional do CâncerBrazilRio de Janeiro, RJ, BrazilDivision of Pathology, Instituto Nacional do Câncer, Rio de Janeiro (RJ), Brazil.

https://orcid.org/0000-0002-7177-9838

Gabriella Campos-do-Carmo

https://orcid.org/0000-0003-2258-5823

Mailing Address: Karen de Almeida Pinto Fernandes. E-mail: karenfernandes22gf@hotmail.com

Conflict of interest: None.

AUTHORS'CONTRIBUTIONS

Karen de Almeida Pinto Fernandes

0000-0002-2689-8248

Preparation and writing of the manuscript

Diana Carolina Salamanca Martinez

0000-0001-9058-2136

Design and planning of the study

Aretha Brito Nobre

0000-0002-7177-9838

Collecting, analysis and interpretation of data

Gabriella Campos-do-Carmo

0000-0003-2258-5823

Intellectual participation in propaedeutic and/or therapeutic conduct of studied cases

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (5)

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Figure 1
A brownish plaque on the lateral face of the right leg, sugges tive of seborrheic keratosis, and a blackened, pa pular lesion with irregular borders at the edge of the plaque, suggestive of melanoacantho ma or melanoma

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Figure 2
Dermatoscopy of the plaque lesion: cerebriform pattern in the upper region of the lesion, central crust, and fingerprint pattern on the border-findings compatible with seborrheic keratosis

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Figure 3
Dermatoscopy of the papular lesion at higher magnification, showing a melanoma-like lesion with blackened blotch, pigment network in the lower region, rosette, pseudopod and bluish-gray veil

Thumbnail

Figure 4
A - On the left, area of hyperkeratosis with papillomatosis, acanthosis and hyperpigmentation of basal keratinocytes, constituting seborrheic keratosis; on the right, intraepithelial neoplasia of pigmented and depolarized keratinocytes, constituting pigmented epidermoid carcinoma in situ (Hematoxylin & eosin, x2); B - mononuclear perivascular inflammatory infiltrate in the upper dermis (Hematoxylin & eosin, x10)

Thumbnail

Figure 5
Hyperkeratosis, foci of parakeratosis, acanthosis, and atypical keratinocytes, sometimes hyperpigmented, occupy the entire thickness of the epidermis; mitotic figures are noted in the upper third of the epidermis; the dermis contains dilated vessels and mononuclear perivascular inflammatory infiltrate with melanophages (Hematoxylin & eosin, x20)

Figure 1 A brownish plaque on the lateral face of the right leg, sugges tive of seborrheic keratosis, and a blackened, pa pular lesion with irregular borders at the edge of the plaque, suggestive of melanoacantho ma or melanoma

Figure 2 Dermatoscopy of the plaque lesion: cerebriform pattern in the upper region of the lesion, central crust, and fingerprint pattern on the border-findings compatible with seborrheic keratosis

Figure 3 Dermatoscopy of the papular lesion at higher magnification, showing a melanoma-like lesion with blackened blotch, pigment network in the lower region, rosette, pseudopod and bluish-gray veil

Figure 4 A - On the left, area of hyperkeratosis with papillomatosis, acanthosis and hyperpigmentation of basal keratinocytes, constituting seborrheic keratosis; on the right, intraepithelial neoplasia of pigmented and depolarized keratinocytes, constituting pigmented epidermoid carcinoma in situ (Hematoxylin & eosin, x2); B - mononuclear perivascular inflammatory infiltrate in the upper dermis (Hematoxylin & eosin, x10)

Figure 5 Hyperkeratosis, foci of parakeratosis, acanthosis, and atypical keratinocytes, sometimes hyperpigmented, occupy the entire thickness of the epidermis; mitotic figures are noted in the upper third of the epidermis; the dermis contains dilated vessels and mononuclear perivascular inflammatory infiltrate with melanophages (Hematoxylin & eosin, x20)

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