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 ().
A 81-year-old white female patient had had a painful tumor at the lateral malleolus of\nthe right ankle for three years. Physical examination revealed an erythematous tumor\nwith a small central ulceration on the right lateral malleolus ( and ). The\nfollowing hypotheses were formulated: cutaneous annex tumor, fibrosarcoma, schwannoma,\ncutaneous lymphoma, basal cell carcinoma and squamous cell carcinoma. Next, a lesion\nbiopsy was performed.\nHistopathology showed epidermis-derived, intertwined epithelial cords, ending in thin\nprojections. Some of these projections had a typical 'crab claw' appearance. Between\nthese cords, a rich fibrovascular stroma is present (). Light formations of the eccrine ducts were identified within some\nof the cords ().\nThe patient was referred to the plastic surgery service, where surgical excision and\nreconstruction by a reverse-flow supramalleolar flap were done (). Three months postoperatively, the patient was completely\nrecovered ().