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Bowenoid papulosis
See also in: Anogenital
Other Resources UpToDate PubMed

Bowenoid papulosis

See also in: Anogenital
Contributors: Precious Cebisile Sibisi MBChB, FCDerm, MMed, Anisa Mosam MBChB, MMed, FCDerm, PhD, Ncoza C. Dlova MBChB, FCDerm, PhD, Susan Burgin MD
Other Resources UpToDate PubMed


Bowenoid papulosis (BP) is a clinical variant of a low-grade squamous cell carcinoma in situ (SCCIS) caused by the human papillomavirus (HPV), usually subtypes 16 and 18, although other subtypes may be responsible. Smoking, early sexual initiation, multiple sexual partners, uncircumcised male sexual partners, and immunosuppression are contributory factors.

There is an equal male-to-female ratio. Lesions are usually asymptomatic, but may be pruritic, and occur primarily in the genital and perianal region.

BP has a variable course, with a frequent potential for spontaneous regression as well as persistence and recurrence. A postsurgical excision recurrence rate in around one-fifth of cases has also been documented.

The risk of progression to invasive SCC in immunocompetent patients is estimated at 2.6%. In immunocompromised patients, the risk of invasive malignancy, including cervical neoplasia, may be higher; one-half of HIV-infected patients with anogenital warts have SCCIS on histology.

BP typically occurs in young sexually active adults. However, cases have been reported in children. Although evidence of pediatric BP does not confirm sexual abuse, the possibility of sexual transmission should be thoroughly investigated.

In 2015, the International Society for the Study of Vulvovaginal Diseases (ISSVD) recommended the term high-grade squamous intraepithelial lesion (HSIL) to encompass all histopathologic diagnoses of vulvar precancer, and does not specifically delineate the clinical entity of BP. Many dermatology textbooks continue to include BP given its distinctive clinical appearance.


D04.9 – Carcinoma in situ of skin, unspecified

402913004 – Bowenoid papulosis

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Differential Diagnosis & Pitfalls

  • The lesions of BP are often mistaken for Genital wart, Lichen planus, and Psoriasis.
  • Unlike Squamous cell carcinoma in situ and Erythroplasia of Queyrat, which are seen in elderly patients, BP is often seen in younger patients.
  • In contrast to BP, the lesions of Seborrheic keratosis occur in elderly patients and are rarely seen on the glans.
  • Lichen nitidus
  • Molluscum contagiosum
  • Fordyce spots
  • Lichen simplex chronicus
  • Cutaneous squamous cell carcinoma
  • Melanoma
  • Nodular basal cell carcinoma
  • Scabies
  • Angiokeratomas (Fordyce angiokeratoma of vulva, Fordyce angiokeratoma of scrotum)
  • Syringoma
  • Secondary syphilis
  • Darier disease
  • Hailey-Hailey disease
  • Papular acantholytic dermatosis

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Last Reviewed:08/11/2019
Last Updated:02/18/2020
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Bowenoid papulosis
See also in: Anogenital
A medical illustration showing key findings of Bowenoid papulosis : Labia majora, Penis, Scrotum, Verrucous scaly papule, Multiple sexual partners
Clinical image of Bowenoid papulosis - imageId=443761. Click to open in gallery.  caption: 'Skin-colored, flat-topped verrucous papules on the penis.'
Skin-colored, flat-topped verrucous papules on the penis.
Copyright © 2024 VisualDx®. All rights reserved.