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 Author(s): Luc Thomas, Amélie Boespflug
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Author(s) Luc Thomas · Amélie Boespflug
Responsible author Luc Thomas→ send e-mail
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Status update June 25, 2018
Status by Ralph P. Braun


Bowen disease, also known as in situ squamous cell carcinoma[1], can affect the nail and the periungual skin or both, and in rare cases it is polydactylic. Nail involvement can reveal a white-to-yellow longitudinal discoloration of the nail plate but pigmented cases are not uncommon. In the latter case, pigmentation is often grayish rather than brown or black.

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Other features of epithelial tumors of the matrix may be observed and include band-disposed splinter hemorrhages, polychromia and subungual localized hyperkeratosis.

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Periungual involvement reproduces the dermoscopic features observed in cutaneous Bowen disease: the presence of irregular desquamation, glomerular (round-shaped at classic × 10 or × 20 dermoscopic magnification but exhibiting a tridimensional pattern resembling the glomerulus apparatus of the kidney at higher magnification) vessels grouped in bunches and dust-like gray pigmentation[2].

Invasive squamous cell carcinoma exhibits quite similar but more prominent features[3] with more common bleeding, thicker localized subungual hyperkeratosis and polychromia. In some cases, the lesion is painful and the pain can be triggered by the pressure induced by the dermoscope.

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References
  1. Dalle S, Depape L, Phan A, Balme B, Ronger-Savlé S, Thomas L. (2007) Squamous cell carcinoma of the nail apparatus: clinicopathological study of 35 cases. Br J Dermatol 156(5): 871–4.
  2. Zalaudek I, Argenziano G, Leinweber B et al. (2004) Dermoscopy of Bowen’s disease. Br J Dermatol 150(6): 1112–16.
  3. Cogrel O, Beylot-Barry M, Doutre MS. (2008) Subungual squamous cell carcinoma revealed by longitudinal erythronychia. Ann Dermatol Venereol 135(12): 883–5.
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