Case Number : Case 2152 - 7 September 2018 Posted By: Dr. Richard Carr

 ? pagetoid dyskeratosis

Bowen's disease with clear cell change.

Looks like pagetoid diskeratosis in a setting of lichen simplex chronicus to me. The underlying cause is hard to tell on this biopsy

In my eyes, those cells are too atypical to render a benign diagnosis on a small biopsy like this.  Agree with Bowen disease  / pagetoid Bowen disease.

Extraocular sebaceous carcinoma in situ?? 

There is a vasculopathic injury in dermis, stasis-dermatitis-like, and  the intraepidermal atypical cells could be a secondary abnormal reaction. So the SCIS could be an odd superimposed event...waiting for the final sentence. 

sir, can we have the final diagnosis here

pagetoid bowen

Yes this is Pagetoid Bowen's.

I also thought about pateoid dyskeratosis but the cells are too atypical for that - the nuclei are too large and not pyknotic, there is no perinuclear halo. I would also classify as Bowen's.

Thanks John. I should point out, in addition to your well made points, pagetoid dyskeratosis is very poorly named because you don't see dyskeratosis!  In this case there is quite obvious dyskeratosis - a clue to Pagetoid Bowen's. p16 should light it up and p53 is often diffuse or completely null. Ki67 will show pennies in the heaven (i.e. all levels of the epidermis and cornified layer).,

Good point Richard!