Letter to the Editor
HPV16-related pigmented Bowen's disease on the palm
Article first published online: 30 JUL 2014
© 2014 European Academy of Dermatology and Venereology
Journal of the European Academy of Dermatology and Venereology
Volume 30, Issue 1, pages 138–140, January 2016
How to Cite
Nakayama, C., Hata, H., Imafuku, K., Toyonaga, E. and Shimizu, H. (2016), HPV16-related pigmented Bowen's disease on the palm. Journal of the European Academy of Dermatology and Venereology, 30: 138–140. doi: 10.1111/jdv.12628
- Issue published online: 23 DEC 2015
- Article first published online: 30 JUL 2014
Bowen's disease (BD) is one of the commonest cutaneous malignancies, regardless of race. Dermatologists occasionally observe BD with varying degrees of melanin deposits within the lesion, a condition called pigmented Bowen's disease (pBD). pBD accounts for 1.7–5.5% of all BD cases; however, pBD on the palm or sole is extremely rare. Herein, we report the first case of human papillomavirus (HPV) 16-related pBD on the palm.
An 85-year-old woman presented with an asymptomatic, hyperkeratotic, peripherally pigmented tumour of 3.5 cm long by 2.8 cm wide by 0.7 cm height on her right palm (Fig. 1a,b). The tumour had gradually developed during the 2 years before the patient came to us on referral. The dermoscopic findings included surface scales, linear brown or gray dots and a hypopigmented structureless zone (Fig. 1c,d). The tumour also showed the parallel furrow pattern that is often seen in nevus pigmentosus. There had been no other verruca vulgaris on the palms and the soles. We performed surgical removal of the entire tumour, and the lesion was found to be histopathologically markedly exophytic and papillomatous (Fig. 2a). Throughout the epidermis, cells arranged in complete disorder were observed, and clumping cells and dyskeratotic cells were often also observed (Fig. 2b). In the dermis, patchy aggregations of melanophages were seen (Fig. 2c). On the basis of these findings, we made the final diagnosis of pBD. We investigated 16 HPV genotypes (genotypes 6, 11, 16, 18, 30, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 66) by multiplex PCR, and then only HPV16 was detected from the lesion (Fig. 2d). Upon receiving this result, the patient underwent cervical cytology; however, she was found to be free of cervical cancer.
HPV16 has been known as a mucosal oncogenic HPV, and the virus is regarded as a high-risk factor in the development of cervical cancer. However, HPV16 has been frequently detected also in BD of the hands.[3, 4] Carcinogenic role of HPV16 in human cutaneous keratinocytes has yet to be elucidated.
In this case, peripheral pigmentation due to melanin deposit was apparent, and some parts of the tumour showed dermoscopic characteristics of acral melanocytic lesions, including the parallel furrow pattern. It is known that HPV4, HPV60 and HPV65 have high amplification rates in pigmented warts. However, a search of the English literature found no reports describing any association between HPV16 infection and pigmented warts or pBD.
In conclusion, this case is the first reported case of HPV16-associated pBD on the palm. The relationship of HPV infection and melanin deposition has not been clarified. Besides, the carcinogenic role of HPV16 in the development of cutaneous malignancies also remains unclear. We expect that more observations of HPV subtypes in pBD of the palm and sole will be accumulated.
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