Subungual Bowen' s Disease Presenting as Longitudinal Melanonychia: a Case Report and Review of 156 Reported Cases with Bowen's Disease of the Nail Apparatus in the Literature

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  • 爪甲色素線条を呈した爪部Bowen病　―症例報告と爪部Bowen病内外報告156例の検討―
  • ソウコウ シキソ センジョウ オ テイシタ ツメブ Bowenビョウ : ショウレイ ホウコク ト ツメブ Bowenビョウ ナイガイ ホウコク 156レイ ノ ケントウ

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<p>Bowen's disease of the nail apparatus is uncommon. We report a case of a 48-year-old man with a pigmented streak on his left index fingernail. Physical examination revealed a well-demarcated, 3-mm-wide brownish streak with nail deformity on the left index fingernail. The streak didn't contact the lateral edge of the nail plate. After confirming a diagnosis of Bowen's disease by excisional biopsy, removal of the entire nail apparatus followed by full-thickness skin-grafting. HPV DNA was detected in the biopsy specimen by PCR using the L1C1/L1C2 consensus primers. The PCR product was analyzed by direct DNA sequencing, which revealed that the sequence corresponded to the L1 gene of HPV type 56. Immunohistochemical staining for HPV and HPV in situ hybridization using a high-risk HPV cocktail probe showed positive results in the epithelium. We reviewed the literature published since 1987 on Bowen's disease of the nail apparatus and summarized 156 cases, including 43 patients presenting as longitudinal melanonychia. The mean age of the patients with Bowen's disease of the nail apparatus was 51.5, years and the male/female ratio was 3.8:1. Eighty-seven percent of the patients in whom HPV examination was performed revealed positive results. HPV genotypes had been analyzed in 20 patients presenting as longitudinal melanonychia. In 13 of them (65%), HPV type 56 had been identified.</p><p>These results suggest that Bowen's disease of the nail apparatus may arise in a younger generation with male predominance, secondary to sexually transmitted HPV infection, and that HPV type 56 may have a propensity for infecting the nail matrix and bed epithelium.</p>

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