We read Dr Letchie's letter with interest and wish he had supported his opinion "that most people with a knowledge of the histopathology of viral infections... would opt for Bowen's disease being a viral infection" with literary references or other objective data. To our knowledge, while a relation of Bowen's disease to arsenic intake has been supported, no convincing evidence for viral etiology has been adduced.1 The one instance in which generalized human virus warts are definitely associated with the development of carcinomas is epidermodysplasia verruciformis, and the resulting invasive squamous cell carcinomas do not usually have a bowenoid phase.1
Dr McLetchie seems to have missed the simple message we tried to convey. After many decades during which viral warts of the genitalia have been known to have the characteristic orderly histologic structure of "condyloma acuminatum," there is now a rash of lesions that clinically are condylomata
Pinkus H, Lupulescu A, Mehregan AH, Rahbari H. Venereal Disease vs Bowen's Disease-Reply. JAMA. 1977;238(23):2496. doi:10.1001/jama.1977.03280240042016
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