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CORRESPONDENCE
Year : 2022  |  Volume : 67  |  Issue : 6  |  Page : 768-769
Uncommon location of bowenoid papulosis


1 Dermatology Service, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
2 Unit of Pathology, Hospital de Barbastro, Huesca, Spain
3 Unit of Ophthalmology, Hospital de Barbastro, Barbastro, Huesca, Spain
4 Unit of Dermatology, Hospital de Barbastro, Barbastro, Huesca, Spain

Date of Web Publication23-Feb-2023

Correspondence Address:
Tamara Gracia-Cazaña
Unit of Dermatology, Hospital de Barbastro, Barbastro, Huesca
Spain
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.ijd_527_21

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How to cite this article:
Meira Sd, Oncins R, Padgett E, Gracia-Cazaña T. Uncommon location of bowenoid papulosis. Indian J Dermatol 2022;67:768-9

How to cite this URL:
Meira Sd, Oncins R, Padgett E, Gracia-Cazaña T. Uncommon location of bowenoid papulosis. Indian J Dermatol [serial online] 2022 [cited 2023 Mar 31];67:768-9. Available from: https://www.e-ijd.org/text.asp?2022/67/6/768/370313




Sir,

A 69-year-old female patient, with no relevant pathological history, presented with a single lesion in the right lip commissure, which developed in the last 2 months, without other associated symptoms.

Physical examination revealed a brownish verrucous papule on the right commissure that fissured with mouth movements [Figure 1]. However, the lesion was not associated with concomitant genital, oral, or periungual involvement.
Figure 1: Brownish verrucous papule on the right commissure

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Excisional biopsy demonstrated koilocytic cells in the upper layers of the epithelium with mild structural disorganization in the epidermis and isolated figures of mitosis in the middle layers [Figure 2].
Figure 2: Acanthosis, superficial koilocytes (star) and atypical keratinocytes with some mitoses (arrow) (H and E × 10)

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An immunohistochemical study was carried out for p53, p16 and Ki67. p53 showed diffuse expression in the basal and focal staining in suprabasal layers. The median value for Ki67 was 15% and p16 was negative. The polymerase chain reaction (PCR) was positive for human papillomavirus (HPV) 16. Because PCR was positive, in situ DNA hybridization was performed and the results were positive for high-risk HPV 16 and 35.

With all of the findings, the diagnosis of extragenital bowenoid papulosis (EBP) was reached.

Regarding the treatment, the lesion was removed and after 1 year of follow-up, the patient had not presented recurrence or new lesions.

Bowenoid papulosis (BP) is an uncommon skin disorder linked to human papillomavirus infection and is clinically characterized by the presence of scattered papules or small multiple and pigmented plaques that involve the stratified squamous epithelium on the anogenital area.[1] Although extragenital BP is usually associated with concomitant genital involvement, a few cases of isolated extragenital BP have been reported.

Mouth BP is a poorly reported pathology. To date, 14 cases have been published in the literature,[1] and only 9 of them were not associated with genital involvement,[1],[2],[3],[4],[5] as in the present case report.

BP is pathologically characterized by presenting the clinical findings of a condyloma acuminatum and is histologically indistinguishable from Bowen's disease.

A recent study has collected the features that allow distinguishing BP from Bowen's disease in the mouth, including those located in the labial commissure.[1]

It has been postulated that in BP, the histological changes are circumscribed to the epidermis level, and the granular layer is usually preserved without cellular atypia; the presence of koilocytes is rare, despite its relationship with viral infection.[6]

Numerous subtypes of HPV have been identified from the DNA in situ hybridization technique in genital BP; however, only 16, 18 and 32 subtypes have been isolated in oral BP, which are considered to be a high risk for the development of malignant lesions; however, only one of the cases of oral BP degenerated to squamous cell carcinoma.[7]

The differential diagnosis of BP lesions in this location should include condyloma acuminatum, florid oral papillomatosis, or focal epithelial hyperplasia.

The treatment required will depend on the extension and location of the lesions, being able to opt for complete resection, physical therapies or topical treatment with imiquimod, 5-fluorouracil, intralesional interferon, etc., However, none of them has demonstrated greater efficacy.[1]

We present a case of extragenital BP; the knowledge of this unusual presentation is important to reach the correct diagnosis and treatment; in addition, screening for possible genital involvement and other associated sexually transmitted infections should be carried out in these patients.

Declaration of patient consent

Although the person is not recognizable, informed consent is available.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Ferreira JCB, de Paula HM, Caixeta GN, Mendonça EF. Distinguisiing bowenoid papulosis from Bowen disease in the mouth: A case report. J Cutan Pathol 2020;47:257-62.  Back to cited text no. 1
    
2.
Daley T, Birek C, Wysocki GP. Oral bowenoid lesions: Differential diagnosis and pathogenetic insights. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:466-73.  Back to cited text no. 2
    
3.
Nakano E, Kunisada M, Ikeda T, Hirose M, Shibuya Y, Komori T, et al. Successful treatment with fluoropyrimidine TS-1 of human papillomavirus type 16-detected multiple oral bowenoid papulosis in an elderly woman. Eur J Dermatol 2012;22:267-8.  Back to cited text no. 3
    
4.
Hoverson AR, Lundell RB, Cooper VL, Bridges AG. Oral bowenoid papulosis. Cutis 2018;102:E27-9.  Back to cited text no. 4
    
5.
Kupetsky EA, Charles CA, Mones J. High-grade squamous intra- epithelial lesion of the oral commissure (bowenoid papulosis). A case and review. Dermatol Pract Concept 2015;5:39-42.  Back to cited text no. 5
    
6.
Requena L, Requena C. Histopathology of the more common viral skin infections. Actas Dermosifiliogr 2010;101:201-16.  Back to cited text no. 6
    
7.
Lookingbill DP, Kreider JW, Howett MK, Olmstead PM, Conner GH. Human papillomavirus type 16 in bowenoid papulosis, intraoral papillomas, and squamous cell carcinoma of the tongue. Arch Dermatol 1987;123:363-8.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2]



 

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