Pigmented Bowen disease : A rare presentation
Bowen's disease (BD), also known as squamous cell carcinoma in situ is a neoplastic skin disease considered as an early stage or intraepidermal form of squamous cell carcinoma.

Pigmented Bowen disease is a rare variant that accounts for 1.7% to 5.5% of all cases of BD. With high prevalence rate in men, exposure to UV radiation, chemicals (eg, arsenic), or HPV, immunosuppression, are known to be related to pigmented BD.

A case of Pigmented BD was presented in a 56-year-old woman with an asymptomatic plaque on the right heel that had grown steadily since last year.

Pigmented lesions were not appreciated on other sites, and lymph nodes were not enlarged. Her medical history included bilateral hearing loss due to encephalitis at an age of 5.

Physical examination revealed a well-defined, irregularly hyperpigmented plaque on the right heel.

For further diagnosis, a biopsy of the lesion was performed for suspected acral malignant melanoma with the following findings:

- Hematoxylin and eosin staining revealed acanthosis
- Elongation of rete ridges
- Keratinocytes in complete disorder with atypical mitoses and pleomorphism affecting the full layer of the epidermis
- The basement membrane was intact
- Melanin pigmentation was increased in the lower epidermis and the upper dermis
- Lymphohistiocytic inflammatory infiltrate was present in the dermis

Further staining for carcinoembryonic antigen and melanoma
antigen recognized by T cells (melan-A) revealed negative results.

Histopathologic findings of varying amount of melanin deposit noted on hematoxylin and eosin staining, with other features of BD, confirmed the patient suffering from Pigmented BD.

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