Bowenoid papulosis in a linear distribution

We have recently encountered a bowenoid papulosis (BP) patient whose lesion distributed in a remarkable linear arrangement. Bowenoid papulosis was characterized by slightly elevated papules or plaques in the genital region that histologically resembled Bowen’s disease (BD) [1]. Its lesions may be discrete or coalesce to form patches, rings to a rare linear patterns [2].
A 31-year-old male was referred to us for evaluation of a progressive, slow-growing lesion over the coronary sulcus of the penis. He had noticed its appearance 2 years before. The patient was otherwise in good health and denied any history of irradiation, trauma, or topical application of podophyllin. There was no antecedent infection of condyloma acuminate or herpes simplex. Skin examination revealed flat, elevated, well-demarcated, pigmented plaques on the coronary sulcus of his penis. These lesions were coalesced to an intermittent linear stripe that was vertical with the shaft of his penis. A few pin-sized similar smaller papules were scattered on the adjacent area (Figure 1). Skin biopsy of the lesion revealed a hyperplastic epidermis with elongated epithelial ridges. There was full-thickness epidermal atypia with loss of orderly maturation, atypical mitosis, and dyskeratotic keratinocytes that were scattered throughout the epidermis. Within the dermis, there was a mild, superficial perivascular lymphocytic infiltrate with a few melanophages (Figure 2). On the basis of the clinical and histological features, the diagnosis of linear Bowenoid papulosis (LBP) was established. The affected area was ablated by a carbon dioxide laser and no relapse was observed after 2 years’ follow-up.
Bowenoid papulosis was first described by Kopf and Bart in 1977 [3]. It predominantly affects individuals in their late third to mid-fourth decade of life. The duration of individual lesions ranges from a few weeks to over 10 years, with a median of 8 months. In men, the penile shaft, glans and foreskin are the most frequent sites of involvement, whereas in females, it primarily affects labia minor, labia major, clitoris, inguinal folds and perianal area [1, 4, 5].
Bowenoid papulosis is commonly marked by macules (less frequent), papules or plaques which is usually less than 1 cm in size. The surfaces of the lesion mostly are flat, dome-shaped, papillomatous and verrucous. Bowenoid papulosis’s colors are highly variable, they can be shiny flesh-colored, pink, reddish-brown, black,...


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