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
Differential Diagnosis & Pitfalls
- The lesions of BP are often mistaken for condyloma, lichen planus, and psoriasis.
- Unlike Bowen disease 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
- Squamous cell carcinoma
- Basal cell carcinoma
- Angiokeratomas (vulvar, scrotal)
- Condyloma lata
- Darier disease
- Hailey-Hailey disease
- Papular acantholytic dermatosis