Stante Marcello, de Giorgi Vincenzo, Massi Daniela, Chiarugi Alessandra, Carli Paolo
Department of Dermatology, University of Florence, Via degli Alfani 37, 50121 Florence, Italy.
Dermatol Surg. 2004 Apr;30(4 Pt 1):541-4. doi: 10.1111/j.1524-4725.2004.30173.x.
Pigmented Bowen's disease (BD) (squamous cell carcinoma in situ) has been rarely described among white patients.
We report the case of a 48-year-old white male presenting a lesion of pigmented BD on his left thigh, clinically mimicking a superficial spreading melanoma.
Naked-eye physical examination revealed a single 1.8 x 1.5 cm, hyperpigmented plaque with a rough surface, which appeared irregularly shaped and sharply demarcated. The assessment of this uncommon tumor by means of dermoscopy, never reported in literature before, was performed. According to standardized terminology, none among the well-established dermoscopic criteria useful to discriminate between melanocytic and nonmelanocytic origin was detected within the lesion. A reticular pigmentation simulated remnants of atypical pigment network, being of uncertain diagnostic value in the preoperative classification of the lesion. Other recognized patterns were irregular, brown globular structures and wide regression-like areas. None of the features diagnostic for pigmented basal cell carcinoma was found as well.
The correct classification of nonmelanocytic origin of the lesion was therefore achieved only at histologic examination, after the complete surgical excision. In spite of its rarity, pigmented BD should be included among those lesions, which may simulate cutaneous melanoma. According to criteria validated by literature, dermoscopy failed to improve a preoperative classification of this peculiar skin tumor.
色素性鲍温病（原位鳞状细胞癌）在白人患者中鲜有报道。
我们报告一例48岁白人男性，其左大腿出现色素性鲍温病病变，临床上酷似浅表扩散性黑色素瘤。
肉眼体格检查发现一个1.8×1.5厘米的单一色素沉着斑块，表面粗糙，形状不规则且边界清晰。通过皮肤镜对这种罕见肿瘤进行了评估，此前文献中从未有过报道。根据标准化术语，在病变内未检测到有助于区分黑素细胞性和非黑素细胞性起源的既定皮肤镜标准。网状色素沉着模拟非典型色素网残留，在病变的术前分类中诊断价值不确定。其他公认的模式是不规则的棕色球状结构和广泛的类似消退区域。也未发现色素性基底细胞癌的诊断特征。
因此，只有在完整手术切除后进行组织学检查，才能正确分类病变的非黑素细胞性起源。尽管色素性鲍温病罕见，但应将其列入可能模拟皮肤黑色素瘤的病变之中。根据文献验证的标准，皮肤镜未能改善这种特殊皮肤肿瘤的术前分类。
