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Bowenoid Papulosis

  • Author: Mary V Kaldas, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Sep 08, 2014
 

Background

Bowenoid papulosis was described in 1977 by Kopf and Bart as papules on the penis. Bowenoid papulosis is now most commonly known to occur on the genitalia of both sexes in sexually active people. Bowenoid papulosis is manifested as papules that are induced virally by human papillomavirus (HPV) and demonstrate a distinctive histopathology (bowenoid dysplasia). Many bowenoid papulosis lesions appear to run a benign course, although a number of case reports associate bowenoid papulosis with malignant invasive transformation (2.6%).

Bowenoid papulosis may be considered to be a transitional state between a genital wart and Bowen disease. The rate of transformation of bowenoid papulosis lesions is unknown. Clearly, bowenoid papulosis lesions have some malignant potential, but they may be treated with locally destructive modalities, sparing the surrounding tissues. Bowenoid papulosis lesions often are multifocal, and patients should be observed for recurrence and for the possibility of invasive or in situ malignancy.

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Pathophysiology

Bowenoid papulosis is an asymptomatic focal epidermal hyperplasia and dysplasia induced by HPV infection[1] (most commonly by HPV 16). The result can appear as a papule or multiple papules that sometimes coalesce, as patches, or as plaques. Histologically, they are composed of scattered atypical cells or full-thickness epidermal atypia that some view as analogous to squamous cell carcinoma in situ. This epidermal atypia is sometimes known as bowenoid dysplasia.

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Epidemiology

Frequency

United States

Bowenoid papulosis lesions are related clinically to genital warts. They share the same age of onset in patients and are transmitted sexually. Because bowenoid papulosis lesions frequently are treated destructively as warts and without histopathologic examination, the true frequency of bowenoid papulosis is unknown but is believed to be underestimated. With locally destructive therapy, the risk of invasive carcinoma in bowenoid papulosis appears to be low.

Mortality/Morbidity

Cervical bowenoid papulosis lesions are associated with an increased incidence of abnormal cervical smears. Although bowenoid papulosis has a low rate of developing invasive characteristics (2.6%), yearly serial examinations are recommended because of the possibility of recurrence.

Race

Bowenoid papulosis affects all races equally.

Sex

The male-to-female ratio for bowenoid papulosis is equal.

Age

Bowenoid papulosis occurs primarily in young, sexually active adults, with a mean age of 31 years. However, reported cases show children as young as 2 years who are affected. One case of a 3-year-old girl[2] with bowenoid papulosis and another case of a 9-year-old girl with vertically acquired HIV and bowenoid papulosis[3] have been reported.

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Contributor Information and Disclosures
Author

Mary V Kaldas, MD Resident Physician in Anatomic Pathology, National Institutes of Health

Disclosure: Nothing to disclose.

Coauthor(s)

Mark P Eid, MD Founder and Director, Virginia Dermatology and Skin Surgery Center

Mark P Eid, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, Pennsylvania Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Lester F Libow, MD Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Mark W Cobb, MD Consulting Staff, WNC Dermatological Associates

Mark W Cobb, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society of Dermatopathology

Disclosure: Nothing to disclose.

Acknowledgements

Edward A DiPreta, MD Dermatologist, DiPreta Dermatology

Edward A DiPreta, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for MOHS Surgery, and Medical Association of Georgia

Disclosure: Nothing to disclose.

Kurt Maggio, MD Director of Dermatologic Surgery and Cutaneous Oncology, Assistant Chief, Department of Dermatology, Walter Reed Army Medical Center

Disclosure: Nothing to disclose.

References
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Bowenoid papulosa histopathology (hematoxylin and eosin, magnification 40X).
Bowenoid papulosa histopathology (hematoxylin and eosin, magnification 400X).
Typical appearance of bowenoid papulosis in the female.
 
 
 
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