A 66-year-old male presented with a pruritic, 3×2 cmsized, erythematous brownish solitary plaque with crusted and verrucous surface on the extensor surface of the right thigh (). The lesion developed 6 to 7 years ago, and had been growing slowly. There was no palpable inguinal lymph node enlargement, and the patient had been otherwise healthy. Biopsy revealed epithelial strands extending down to the dermis, forming anastomoses (). Epithelial strands were composed of 2 areas: the upper area consisting of dysplastic cells with prominent nucleoli and abundant mitoses, and the lower area consisting of oval and round cells, and occasionally small luminal ducts (). Dysplastic cells comprised almost the entire epidermis but did not invade into the dermis (). There was a sharp contrast and demarcation between the upper dysplastic lesion and the benign adenomatous lesion immediately surrounding the dysplastic keratinocytes in the lowermost portion of the epidermis (). In immunohistochemical stains, epithelial membrane antigen (EMA) was positive in the dysplastic cells and weakly positive in the ductal structures in the adenomatous lower portion (). p63 was more intensely positive in the dysplastic cells than in the adenomatous cells (). Carcinoembryonic antigen (CEA) stain was weakly positive in the ductal structures in the adenomatous lower portion (). The lesion was diagnosed as a reactive ESFA associated with Bowen's disease and was completely excised with free margins of the tumor. Histopathology of excised tissues was also consistent with reactive ESFA associated with Bowen's disease ().
Female patient, 41 years old, of mixed race, from Tremedal, Bahia, came to the\ndermatology ambulatory reporting that since birth she had not had hair anywhere in\nher body besides nail dystrophy and palmoplantar hyperkeratosis ( and ). She denied previous history of cutaneous neoplasms, dental\nabnormalities, intolerance to heat or other significant medical problems and also\ninformed that two of her siblings presented similar symptoms.\nShe reports that for 10 years coalescent papules and nodules of pinkish color,\nverrucous aspect appeared on her feet and hands, growing in number and size with\ntime. She denied pain, burning sensation or bleeding at the site of the cutaneous\nlesions.\nDuring physical examination the presence of coalescent pinkish papules was noticed,\nforming plaques with cobblestone aspect on the feet, besides alopecia and nail\ndystrophy. Laboratory exams were normal. The possible differential diagnoses of\ncutaneous lesions included diffuse eccrine poromatosis, plane warts, Clouston\nSyndrome, pachyonychia congenita and other forms of ectodermal dysplasias ().\nAn incisional biopsy of the right foot lesion was performed, which revealed thin\ncords of anastomosed epithelial cells in continuity with the epidermis. The cords\nwere composed of round and oval nucleated cells. Luminal structures which varied in\nsize were also found, whose walls contained a single layer of cells. These findings\nwere compatible with the diagnosis of ESFA (. PCR for HPV 10 was negative.