To the Editor.—
Recently, Lloyd recorded the first case of multicentric pigmented Bowen's disease of the groin.1 To underline this distinctive variant of Bowen's disease, we would like to describe a similar patient in whom the clinical diagnosis was missed.
Report of a Case
A 34-year-old Lebanese man presented with two brownish-black pruritic plaques over the prepuce of 2 years' duration. The plaques were roughly circular, each measuring about 5 mm in diameter. They were slightly elevated and sharply demarcated, having a smooth velvety surface. The lesions had remained stationary. The clinical diagnoses considered were seborrheic keratosis and lichen planus. There was no response to topically or intralesionally administered steroids.A biopsy showed diffuse epidermal hyperplasia. The prickle cells appeared disorganized with foci of atypical changes consisting of loss of polarity, hyperchromasia, and dyskeratoses Many mitotic figures were seen (Figure). The basal cell layer was intact but was heavily