Abstract

A 74-year-old man presented with a 5 mm tan papule located on the dorsal penis. Clinically, the lesion was suspected to be a traumatized nevus due to its pigmented appearance. A shave biopsy revealed a pigmented squamous cell carcinoma (Bowen’s disease), characterized by hyperkeratosis, parakeratosis, acanthosis, and in-situ malignant dyskeratosis with a Bowenoid growth pattern. There was strong and diffuse p16 staining within the lesional cells, which confirmed a high-risk HPV-related lesion. Additionally, there was a diffuse deposition of pink amorphous material extending from the upper papillary dermis throughout the remaining dermis, that was recognizable as amyloid. The amyloid was positive on a Congo Red stain and showed apple green birefringence under polarized light. While there has been an association between β-HPV subtypes and cutaneous squamous cell carcinoma, there is also evidence to suggest α-HPV subtypes play a role in Bowen’s disease pathogenesis when HPV is implicated. Amyloid deposition is another feature that has been infrequently reported in Bowen’s disease but may be more common than reported, with one case series finding 5.8% of cases of Bowen’s disease to present with secondary localized cutaneous amyloidosis. There may be an emerging association between amyloidosis and genital Bowen’s disease; however, the clinical significance is not well understood. The relationship between amyloid and HPV-induced intraepithelial lesions of the genitalia may pose a risk for other amyloid deposits in these patients.