A Rare Convergence: Verrucous Squamous Cell Carcinoma Arising From Bowen’s Disease in an Uncommon Cutaneous Location

TL;DR

This paper describes a rare case where a specific type of skin cancer developed from another skin condition in an unusual location.

Contribution

The novelty lies in reporting a rare case of VSCC arising from BD in an uncommon cutaneous location.

Findings

VSCC arose from BD in the lower back, an uncommon site for both conditions.

Histopathological examination confirmed dual pathology of VSCC and adjacent BD.

The case emphasizes the need for accurate diagnosis to guide surgical planning.

Abstract

Verrucous squamous cell carcinoma (VSCC) and Bowen’s disease (BD) are neoplasms of squamous cell origin. Bowen’s disease is the widely used term for squamous cell carcinoma in situ and primarily involves the skin, whereas VSCC represents a well-differentiated, locally aggressive variant of squamous cell carcinoma. These entities differ in their risk factors, biological behavior, and therapeutic approach. Cutaneous VSCC is typically human papillomavirus-independent (HPV-independent) and often requires wide local excision, while BD is frequently associated with HPV infection, arises on sun-exposed skin, and may respond to non-surgical treatment modalities. We report a rare case of VSCC arising in a background of Bowen’s disease over the lower back--an uncommon site for both lesions. The patient underwent wide local excision with Limberg flap reconstruction, and histopathological examination confirmed VSCC with adjacent Bowen’s disease. This case highlights the importance of recognizing dual pathology in atypical cutaneous lesions to ensure appropriate surgical planning and management.

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