LAUSR

Dear Editor, Pigmented Bowen's disease (pBD) is an uncommon presentation of Bowen's disease that may clinically resemble malignant melanoma (MM).1 Here, we report a case of pBD presenting with atypical dermoscopic findings in a patient who was diagnosed with MM 4 years prior. A 51yearold female patient (Skin type:3) presented with a hyperpigmented macule on the left proximal thigh. The patient had been followed up in our melanoma department. Four years prior, she was diagnosed with a cutaneous MM which was presented on the lateral aspect of the left thigh. It was excised with a wide margin, and the pathological report from the excisional biopsy revealed a nodular melanoma with a mitotic rate of 5– 6/mm and a low inflammatory infiltrate throughout the tumor or along it (Clark level III and Breslow 3 mm). At the time of the excision, no evidence of distant metastasis or pathological regional lymph node spread was noted, and no other atypical melanocytic lesions were observed. Subsequently, the scar was excised with an additional margin. No further therapy was planned, and she had been under regular followup since then without any signs of relapse. During the followup, a suspicious lesion was detected on the proximal thigh, next to the inguinal area. She had noticed the lesion 1 month prior. Clinical examination revealed a 1 cm hyperpigmented (dark brown and light brown) macule with asymmetric borders. Dermoscopic examination revealed asymmetry of color and shape, with varying degrees of brown color, irregular dots cumulated peripherally, structureless areas, scarlike structures, and also streaklike structures. No significant vascular structures were noted in dermoscopic examination (MoleMax HD digital dermoscopy; Derma Medical Systems, Figure 1). An excisional biopsy was performed with the suspicion of MM, and the histopathologic examination showed a fullthickness intraepidermal proliferation of atypical keratinocytes with overlying parakeratosis, focal dyskeratosis, and increased melanin pigmentation (Figure 2). Based on these findings, a diagnosis of pBD was established. Since the surgical margins were negative, no additional treatment was required. The patient is on followup. pBD is a rare variant of Bowen's disease (BD), and it has been reported to be 1.7% to 6% of all BD cases.2 Dermatoscopy is useful in F I G U R E 1 Dermoscopic examination: Asymmetry of color and shape, with a red lesion with light brown and dark brown areas, irregular dots cumulated peripherally, structureless areas, scarlike structures, and also streaklike structures (MoleMax HD digital dermoscopy; Derma Medical Systems)