Volume 20 Number 4 April 2014 Photo Vignette Pigmented Bowen's disease of the penis and scrotum in a patient with AIDS Najla A Al-Dawsari MD FAAD, Wasim Raslan MD PhD FCAP, M. Fawaz Dawamneh MD FCAP Dermatology Online Journal 20 (4): 16 Saudi Aramco Medical Services Organization, Saudi Arabia Correspondence: Najla A Al-Dawsari Dhahran Health Center Saudi Aramco Medical Services Organization, Saudi Arabia najla.aldawsari@gmail.com Introduction Patients with HIV have higher risk of developing squamous cell carcinoma of the skin given the increased risk of HPV infection, which alters cell proliferation and apoptosis [1]. Pigmented Bowen’s disease is an uncommon form of squamous cell carcinoma in-situ characterized by pigmented lesions that can clinically mimic superficial spreading melanoma, pigmented basal cell carcinoma, melanocytic nevus, Bowenoid papulosis, and seborrheic keratosis [2,3,4]. Key words: Bowen's disease; AIDS; Melanoma; squamous cell carcinoma in-situ Case synopsis A 42-year-old, Fitzpatrick skin type V, circumcised Middle Eastern male with AIDS (CD4 count =30, viral load=142 copies/ml) was evaluated for a three-year history of two gradually enlarging lesions of the penis and scrotum. The lesions were asymptomatic and the patient did not consider seeking medical attention until he was admitted to the hospital with Candida esophagitis. The admitting physician noticed both lesions while performing a full physical exam. He is not a smoker. There was no history of exposure to radiation, tar or arsenic. He was not complaint to his antiretroviral treatment and denied any personal or family history of skin cancer. On physical examination of the left half of scrotum, there was a dark brown plaque with irregular borders and a few whitish speckles at the center measuring approximately 2 cm in the widest diameter (Fig. 1). On the ventral aspect of the penis, there was a brown flat-topped plaque with few white speckles at one edge measuring approximately 1.5 cm in the widest diameter (Fig. 2). Figure 1. Penile skin showing brown non-scaly plaque with areas of white speckles and irregular borders.