Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Art & Psychiatry
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Conference Oration
Conference Summary
Continuing Medical Education
Cosmetic Dermatology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
Editor Speaks
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Miscellaneous Letter
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News & Views
Observation Letter
Observation Letters
Original Article
Original Contributions
Pattern of Skin Diseases
Pediatric Dermatology
Pediatric Rounds
Presedential Address
Presidential Address
Presidents Remarks
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Review Article
Review Articles
Revision Corner
Self Assessment Programme
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Study Letter
Study Letters
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapy Letter
View Point
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter to the Editor
doi: 10.4103/0378-6323.144204
PMID: 25382524

Pigmented Bowen's disease with prominent amyloid deposition on the eyelid

Takamichi Ito1 , Maiko Wada1 , Yuki Kuma1 , Makiko Kido-Nakahara1 , Yuichi Yamada2 , Shinji Okano3 , Yoshinao Oda2 , Masutaka Furue1
1 Department of Dermatology, Division of Pathophysiological and Experimental Pathology, Graduate School of Medical Sciences, Kyushu University, Japan
2 Department of Dermatology,Anatomical Pathology, Division of Pathophysiological and Experimental Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
3 Department of Dermatology, Pathology, Division of Pathophysiological and Experimental Pathology, Graduate School of Medical Sciences, Kyushu University, Japan

Correspondence Address:
Takamichi Ito
Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582
How to cite this article:
Ito T, Wada M, Kuma Y, Kido-Nakahara M, Yamada Y, Okano S, Oda Y, Furue M. Pigmented Bowen's disease with prominent amyloid deposition on the eyelid . Indian J Dermatol Venereol Leprol 2014;80:558-560
Copyright: (C)2014 Indian Journal of Dermatology, Venereology, and Leprology


Bowen′s disease is a clinical expression of squamous cell carcinoma in situ of the skin. It typically arises in sun-exposed areas of older, fair-skinned individuals. [1] While most cases of Bowen′s disease in the fair-skinned develop as a non-pigmented pink macule, pigmented variants can occur, especially in the anogenital area; pigmented lesions on the eyelid are rather rare. Herein, we present a case of pigmented Bowen′s disease that showed an unusual appearance clinically and dermoscopically.

A 45-year-old Japanese man presented with a two-year history of a brown macule on the right lower eyelid. Physical examination revealed that the macule was 5 mm in size and had an irregular border and slightly papillomatous surface [Figure - 1]a. Dermoscopy showed a brain-like brown structure (arrow) without obvious vessel structure or scaly surface. Small pale-pink patches were arranged in part of the macule in a flower-like fashion (circle) [Figure - 1]b. We surgically resected it after the diagnosis of Bowen′s disease was made by punch biopsy. Histopathologically, the full thickness of the epidermis had been replaced by atypical keratinocytes with occasional clumping and dyskeratotic cells. Mild chronic inflammatory cells were observed in the dermis. Of note, abundant Dylon staining-positive amorphous deposits were found in the upper to mid-dermis [Figure - 1]c-e. These deposits showed green birefringence with polarized light and were weakly positive for Cytokeratin AE 1/3, findings that were consistent with secondary localized cutaneous amyloidosis.

Figure 1: (a) A brown plaque on the right lower eyelid. (b) Dermoscopy. A brain-like brown structure (arrow) and small pale-pink patches arranged in a fl ower-like fashion (circle). An arrowhead indicates a biopsy scar. (c, d) Full thickness of the epidermis replaced by atypical keratinocytes, mild chronic inflammatory cells and amyloid deposition in the dermis. The epidermis on the left side shows relatively regular acanthosis by atypical keratinocytes and scarce amyloid deposition. The right side also shows Bowen's disease, with irregularly elongated rate ridges, abundant amyloid deposition and underlying infl ammatory cell infi ltrates. c: H and E staining ×20; d: Dylon staining ×20, (e) High-power view of the specimen reveals atypical keratinocytes, occasional clumping cells and dyskeratotic cells

Bowen′s disease is a superficial variant of cutaneous squamous cell carcinoma that occasionally develops into an invasive squamous cell carcinoma with an aggressive course; accurate diagnosis and appropriate treatment are necessary. It usually presents as an asymptomatic well-defined erythematous scaly plaque and making a correct diagnosis is generally easy; however, in some cases such as the pigmented variant, diagnosis may be a challenge. Only 1.7%-5.5% of cases in the fair-skinned are pigmented, and they are often misdiagnosed as seborrheic keratosis or various melanocytic lesions. [2],[3]

Dermoscopy is now applied to various skin lesions and its potential to improve the diagnostic accuracy has been acknowledged. Typical dermoscopic features of non-pigmented Bowen′s disease include glomerular vessels and surface scales. [4] In contrast, according to a detailed study on dermoscopy of the pigmented variant, a linear arrangement of brown or gray dots and coiled vessels represent clues to the diagnosis. [3] However, none of these findings was apparent in our patient which made it difficult to reach a diagnosis. In our case, there was dense pigmentation in the basal layer, incontinence of pigment in the papillary dermis, and prominent amyloid deposition in both the papillary and the reticular dermis. The brain-like lesion on dermoscopy (arrow in [Figure - 1]b) accorded with the lesion histopathologically showing a thickened epidermis and marked basal pigmentation (left part of [Figure - 1]c and d). It is likely that the thick epidermis and pigmentation obscured the underlying vessel structure. The flower-like patches, indicated by the circle in [Figure - 1]b, may reflect irregularly elongated rete ridges with basal pigmentation and underlying amyloid deposition (right part of [Figure - 1]c and d). Chuang et al. have reported a homogeneous white structure ("central hub") surrounded by radiating pigmentation as a specific dermoscopic feature of cutaneous amyloidosis. [5] Our finding of flower-like patch may correspond to grouped central hubs.

Amyloid deposition in Bowen′s disease is well known and the amyloid is considered to be derived from cytokeratin. A significant quantity of amyloid was deposited relatively deeply in the dermis in our patient, and the amyloid continued to the bottom of the lesion, giving a smooth contour overall. We speculate that the amyloid deposits were vestiges of tumor cell regression by host reaction. This hypothesis seems to be supported by lymphocytic infiltrates in the dermis and around the amyloid foci.


The authors thank Ms. Yuka Eguchi for her technical support with the immunostaining.

Weedon D. Tumor of the epidermis. In: Weedon D, editor. Weedon's Skin Pathology. Philadelphia: Churchill Livingstone Elsevier; 2010. p. 679-81.
[Google Scholar]
Ragi G, Turner MS, Klein LE, Stoll HL Jr. Pigmented Bowen's disease and review of 420 Bowen's disease lesions. J Dermatol Surg Oncol 1988;14:765-9.
[Google Scholar]
Cameron A, Rosendahl C, Tschandl P, Riedl E, Kittler H. Dermatoscopy of pigmented Bowen's disease. J Am Acad Dermatol 2010;62:597-604.
[Google Scholar]
Zalaudek I, Kreusch J, Giacomel J, Ferrara G, Catricalà C, Argenziano G. How to diagnose nonpigmented skin tumors: A review of vascular structures seen with dermoscopy: Part II. Nonmelanocytic skin tumors. J Am Acad Dermatol 2010;63:377-86.
[Google Scholar]
Chuang YY, Lee DD, Lin CS, Chang YJ, Tanaka M, Chang YT, et al. Characteristic dermoscopic features of primary cutaneous amyloidosis: A study of 35 cases. Br J Dermatol 2012;167:548-54.
[Google Scholar]

Fulltext Views

PDF downloads
Show Sections