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Bowen disease (intraepidermal squamous cell carcinoma) can develop on sun-exposed and non–sun-exposed skin. The lesion is usually a small (0.5–3 cm), well-demarcated, slightly raised, pink to red, scaly plaque and may resemble psoriasis or a large actinic keratosis (eFigure 6–20). Lesions may progress to invasive squamous cell carcinoma. Excision or other definitive treatment such as topical treatment (fluorouracil or imiquimod) or photodynamic therapy is indicated.

eFigure 6–20.

This isolated, scaly patch on a patient's arm turned out to be Bowen disease (intraepidermal squamous cell carcinoma) on biopsy. (Used, with permission, from S Goldstein, MD.)

Extramammary Paget disease, a manifestation of intraepidermal carcinoma or underlying genitourinary or GI cancer, resembles chronic eczema and usually involves apocrine areas such as the genitalia. Mammary Paget disease of the nipple, a unilateral or rarely bilateral red scaling plaque that may ooze, is associated with an underlying intraductal mammary carcinoma (see Figure 17–3). While these lesions appear as red patches and plaques in fair-skinned persons, in darker-skinned individuals, hyperpigmentation may be prominent.

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