Concise report CED Clinical and Experimental Dermatology Clinical and dermoscopic features of genital pigmented Bowen disease R. Giuffrida, 1 C. Conforti, 2 F. S. S. Resende, 2 M. Hamilko de Barros, 3 M. Uranitsch, 2 F. Favero, 2 T. Deinlein, 4 R. Hofmann-Wellenhof 4 and I. Zalaudek 5 1 Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy; 2 Department of Dermatology and Venereology, University of Graz, Graz, Austria; 3 Professor Rubem David Azulay Institute, Charity Hospital of Rio de Janeiro, Rio de Janeiro, Brazil; 4 Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria; and 5 Department of Dermatology and Venereology, University of Trieste, Ospedale Maggiore, Trieste, Italy doi:10.1111/ced.13633 Summary Pigmented Bowen disease (pBD) is an uncommon variant of squamous cell carcin- oma in situ. Sometimes it can show clinical and dermoscopic features that are seen in other pigmented lesions of the skin and mucosa, making the diagnosis difficult. We report six cases of pBD occurring on the anogenital area, and discuss the impor- tance of dermoscopy for improving the diagnostic accuracy in pBD. Bowen disease (BD) is a common variant of squa- mous cell carcinoma (SCC) in situ of the skin. It often occurs on chronically sun-exposed skin of elderly people. 1,2 BD is usually not pigmented, but pigmented BD (pBD) is an occasional occurrence. 1 The pigmented variant represents only up to 6% of all BD lesions, 2 and its location on the genital area is uncommon in white populations. 3,4 pBD is a great masquerader and can clinically mimic a wide range of skin tumours. In recent years, dermoscopy has become a widely used diagnostic tool, because it increases the specificity and sensitivity of examination of pigmented and non- pigmented skin tumours compared with the naked eye. 5 While the dermoscopic patterns of cutaneous pigmented and nonpigmented BD have been studied extensively, little is currently known about the dermo- scopic patterns of genital pBD. We report the clinical and dermoscopic features seen in six cases of pBD occurring in the anogenital area. Report We report the cases of six white patients (three men, three women; mean age: 56.5 years, range 49–69 years) referred to our clinic with asymptomatic and slowly enlarging pigmented lesions located on the gen- ital area (two patients had them on the left inguinal region, two on the penis, one on the perianal region and one on the vulva) (Fig. 1, Fig. 2). None of the patients had a history of promiscuity, chronic arsenic exposure, immunosuppression, or other significant skin or internal diseases. Dermoscopically, structure- less hypopigmented or hyperpigmented areas and glomerular vessels were present in all our cases (Fig. 1, Fig. 2). Most vessels were arranged in lines at the periphery. A linear arrangement of brown or grey dots was seen in two lesions (Patients 1 and 5), while sharp demarcation was clearly visible in Patients 2 and 3. Details of the patient demographics and the clinical and dermoscopic characteristics of the six lesions are summarized in Table 1. All patients under- went surgery, and histopathological evaluation con- firmed pBD. pBD is a rare variant of SCC in situ of the skin and mucous membranes. 1 Although pBD typically arises on chronically sun-exposed body sites, it is not limited to these sites. 4 pBD on sun-protected body areas pre- vails in dark-skinned people. 2,3 The development of pBD on the genital area seems rare, with only a few cases reported and dermoscopically evaluated in the Correspondence: Professor Iris Zalaudek, Department of Dermatology and Venereology, University of Trieste, Ospedale Maggiore, Trieste, 34129, Italy E-mail: iris.zalaudek@gmail.com Conflict of interest: the authors declare that they have no conflicts of interest. Accepted for publication 26 December 2017 Clinical and Experimental Dermatology 1 ª 2018 British Association of Dermatologists