Bowen Disease of the Nail Bed Presenting as Longitudinal Melanonychia: Detection of Human Papillomavirus Type 56 DNA

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Bowen Disease of the Nail Bed Presenting as Longitudinal Melanonychia: Detection of Human Papillomavirus Type 56 DNA

Bowen disease (BD) of the nail unit has multiple clinical presentations, often making its diagnosis challenging. BD is a squamous cell carcinoma (SCC) in situ with various cited etiologic causes, including ionizing and nonionizing radiation, hydrocarbon exposure, trauma, arsenic ingestion, chronic paronychia, ectodermal dysplasia, and dyskeratosis congenita.1-4 Human papillomavirus (HPV) has been associated with the pathogenesis of BD and SCC of the anogenital, oral, and periungual regions.3-9 Specifically, HPV-16 is well recognized as the predominant type associated with periungual BD and SCC, though HPV-34, -35, and -73 also have been identified.2-8 We describe the case of a 25-year-old African American man with BD of the third right fingernail presenting as longitudinal melanonychia (LM), in which HPV-56 DNA was identified. back to top


CASE REPORT A 25-year-old African American man presented to our dermatology service for evaluation of a pigmented streak of the third right fingernail that had been present for several years. Findings from the examination revealed a band of LM on the right third fingernail associated with overlying linear dystrophy of the nail plate. There was no periungual extension of pigmentation onto the adjacent cuticle or the lateral nail fold (Figure 1).


A 3-mm punch biopsy of the proximal nail matrix was performed and revealed acanthosis, hyperkeratosis, and full-thickness epidermal atypia (Figure 2). Hypergranulosis and koilocytic changes were noted (Figure 3). MART-1 (melanoma antigen recognized by T cells 1) staining demonstrated a normal number and distribution of melanocytes.
Polymerase chain reaction amplification, with subsequent hybridization with probes specific to the DNA of HPV, showed strong positivity for HPV-56. Mohs micrographic surgery was performed to excise the tumor with clear margins (Figure 4). The wound was primarily closed using a modified running winch stitch (Figure 5). An anogenital examination performed during follow-up was negative for any verrucous lesions. back to top


Comment BD of the nail unit commonly has been described as wartlike but may present as periungual erythema with associated crusting, ulceration or fissuring, paronychia, onychocryptosis, or nail dystrophy, with eventual partial to complete degeneration of the nail.1,10 The digits of the hands are more commonly involved than the feet.10 In most cases, a single digit is involved, with the thumb being the most common. More invasive disease should be suspected in nodular cases and when bleeding and ulceration occur.5,10 LM is another presentation of BD involving the nail unit first described by Baran and Simon11 in 1988.

Sass et al2 described the first case of BD presenting as LM, in which HPV-16 was identified, and further demonstrated genomic integration of the viral DNA in the chromosomal host DNA. HPV infection, especially type 16, has been implicated both in the pathogenesis of anogenital and oral BD2-4,7 and in the development of BD or invasive SCC in the periungual area.1-4,6 In addition, HPV-34, -35, and -73 have been described.4,7,8

HPVs related to mucosal or genital lesions likely play an important role in the pathogenesis of BD and invasive SCC in the periungual region.3,5,7 Guitart et al5 described a case in which similar HPV genomes were detected in a uterine cervical neoplasia and a subungual SCC in the same patient. Similarly, Rudlinger et al12 described a patient with HPV-35 positive bowenoid papulosis in the anogenital region who presented 11 years later with bowenoid dysplasia of a verruca on the right ring finger with the same HPV type. The presence of the same HPV type in both anogenital and periungual regions occurring in the same patient could be explained through autoinoculation or direct contact.1,3,5,7 This is consistent with the observation that extragenital BD lesions are found more commonly in the upper extremities.1,3,7

Lorincz et al13 first reported HPV-56 in 1989 after having been detected in invasive cervical cancers. HPV-56 is included in the high-risk group of HPV types often detected in either cervical intraepithelial neoplasia or invasive cancers, or both.3,9,13 In 1999, Uezato et al3 reported the first case in which HPV-56 was found in extragenital BD. The lesion occurred on the first great toe of an 81-year-old Japanese woman who subsequently underwent surgery, including skin grafting, without evidence of recurrence. To our knowledge, our case represents the second report in which HPV-56 was found in a case of extragenital BD.

The prognosis for patients with BD involving the nail unit is good. In the case of invasive carcinoma of the nail unit, the reported incidence of local bone invasion ranges from 18% to 60%.14-16 The high rate of local invasion may reflect a delay in diagnosis due to patient neglect and/or confusion regarding the clinical presentation. Metastatic disease is rare. However, it has been reported in 4 cases, one of which is a patient with hereditary ectodermal dysplasia.4,15,17,18

Surgical removal is the preferred therapeutic intervention, with either simple excision followed by skin graft or healing by secondary intention.1,10,19 Mohs micrographic surgery is the treatment of choice, allowing for complete removal of the tumor with maximal preservation of normal tissue and physiologic function.1,10,19

In conclusion, our case represents the first report of BD of the nail unit associated with HPV-56. As new HPV subtypes are identified and classified according to their oncogenic potential, the well-established association among high-risk HPV types in both anogenital and nail unit neoplasias is reinforced by these reports. Recognition of LM as a presenting sign of nail unit BD may result in early diagnosis and treatment. back to top

 

References

 

  1. Sau P, McMarlin ST, Sperling L, et al. Bowen’s disease of the nail bed and periungual area: a clinicopathologic analysis of seven cases. Arch Dermatol. 1994;130:204-209.
  2. Sass U, Andre J, Stene JJ, et al. Longitudinal melanonychia revealing an intraepidermal carcinoma of the nail apparatus: detection of integrated HPV-16 DNA. J Am Acad Dermatol. 1998;39:490-493.
  3. Uezato H, Hagiwara K, Ramuzi ST, et al. Detection of human papillomavirus type 56 in extragenital Bowen’s disease. Acta Derm Venereol. 1999;79:311-313.
  4. McHugh RW, Hazen P, Eliezri YD, et al. Metastatic periungual squamous cell carcinoma: detection of human papillomavirus type 35 RNA in the digital tumor and axillary lymph node metastases. J Am Acad Dermatol. 1996;34:1080-1082.
  5. Guitart J, Bergfeld WF, Tuthill RJ, et al. Squamous cell carcinoma of the nail bed: a clinicopathological study of 12 cases. Br J Dermatol. 1990;123:215-222.
  6. Kawashima M, Jablonska S, Favre M, et al. Characterization of a new type of human papillomavirus found in a lesion of Bowen’s disease of the skin. J Virol. 1986;57:688-692.
  7. Mitsuishi T, Sata T, Matsukura T, et al. The presence of mucosal human papillomavirus in Bowen’s disease of the hands. Cancer. 1997;79:1911-1917.
  8. Moy RL, Eliezri YD, Nuovo GJ, et al. Human papillomavirus type 16 DNA in periungual squamous cell carcinomas. JAMA. 1989;261:2669-2673.
  9. Schiffman MH, Kiviat NB, Burk RD, et al. Accuracy and interlaboratory reliability of human papillomavirus DNA testing by hybrid capture. J Clin Microbiol. 1995;33:545-550.
  10. Mikhail GR. Subungual epidermoid carcinoma. J Am Acad Dermatol. 1984;11:291-298.
  11. Baran R, Simon C. Longitudinal melanonychia: a symptom of Bowen’s disease. J Am Acad Dermatol. 1988;18:1359-1360.
  12. Rudlinger R, Grob R, Yu YX, et al. Human papillomavirus-35-positive bowenoid papulosis of the anogenital area and concurrent human papillomavirus-35-positive verruca with bowenoid dysplasia of the periungual area. Arch Dermatol. 1989;125:655-659.
  13. Lorincz AT, Quinn AP, Goldsborough MD, et al. Human papillomavirus type 56: a new virus detected in cervical cancers. J Gen Virol. 1989;70:3099-3104.
  14. Lumpkin LR, Rosen T, Tschen JA. Subungual squamous cell carcinoma. J Am Acad Dermatol. 1984;11:735-738.
  15. Campbell CJ, Keokarn T. Squamous cell carcinoma of the nail bed in epidermal dysplasia. J Bone Joint Surg. 1966;48:92-99.
  16. Long PI, Espiniella JL.
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This article has been peer reviewed and approved by Michael Fisher, MD, Professor of Medicine, Albert Einstein College of Medicine. Review date: September 2003.

Drs. Lambiase, Gardner, Altman, and Albertini report no conflict of interest. The authors report no discussion of off-label use. Dr. Fisher reports no conflict of interest. Drs. Lambiase, Gardner, and Altman are from the Department of Dermatology, San Antonio Uniformed Services Health Education Consortium, Fort Sam Houston, Texas, where Drs. Lambiase and Altman are Senior Dermatology Residents. Dr. Gardner is Associate Professor of Dermatology at the University of Texas at San Antonio. Dr. Albertini is a Mohs surgeon at the Skin Surgery Center, Winston-Salem, North Carolina.
The opinions or assertions expressed in this article are those of the authors and do not reflect the views of the US Army, US Air Force, or US Department of Defense.

CPT Matthew C. Lambiase, MC, USA; MAJ Timothy L. Gardner, MC, USA; CPT Coleman E. Altman, MC, USA; John G. Albertini, MD

Accepted for publication August 12, 2003. Drs. Lambiase, Gardner, and Altman are from the Department of Dermatology, San Antonio Uniformed Services Health Education Consortium, Fort Sam Houston, Texas, where Drs. Lambiase and Altman are Senior Dermatology Residents. Dr. Gardner is Associate Professor of Dermatology at the University of Texas at San Antonio. Dr. Albertini is a Mohs surgeon at the Skin Surgery Center, Winston-Salem, North Carolina.
The opinions or assertions expressed in this article are those of the authors and do not reflect the views of the US Army, US Air Force, or US Department of Defense.

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This article has been peer reviewed and approved by Michael Fisher, MD, Professor of Medicine, Albert Einstein College of Medicine. Review date: September 2003.

Drs. Lambiase, Gardner, Altman, and Albertini report no conflict of interest. The authors report no discussion of off-label use. Dr. Fisher reports no conflict of interest. Drs. Lambiase, Gardner, and Altman are from the Department of Dermatology, San Antonio Uniformed Services Health Education Consortium, Fort Sam Houston, Texas, where Drs. Lambiase and Altman are Senior Dermatology Residents. Dr. Gardner is Associate Professor of Dermatology at the University of Texas at San Antonio. Dr. Albertini is a Mohs surgeon at the Skin Surgery Center, Winston-Salem, North Carolina.
The opinions or assertions expressed in this article are those of the authors and do not reflect the views of the US Army, US Air Force, or US Department of Defense.

CPT Matthew C. Lambiase, MC, USA; MAJ Timothy L. Gardner, MC, USA; CPT Coleman E. Altman, MC, USA; John G. Albertini, MD

Accepted for publication August 12, 2003. Drs. Lambiase, Gardner, and Altman are from the Department of Dermatology, San Antonio Uniformed Services Health Education Consortium, Fort Sam Houston, Texas, where Drs. Lambiase and Altman are Senior Dermatology Residents. Dr. Gardner is Associate Professor of Dermatology at the University of Texas at San Antonio. Dr. Albertini is a Mohs surgeon at the Skin Surgery Center, Winston-Salem, North Carolina.
The opinions or assertions expressed in this article are those of the authors and do not reflect the views of the US Army, US Air Force, or US Department of Defense.

Author and Disclosure Information

 

This article has been peer reviewed and approved by Michael Fisher, MD, Professor of Medicine, Albert Einstein College of Medicine. Review date: September 2003.

Drs. Lambiase, Gardner, Altman, and Albertini report no conflict of interest. The authors report no discussion of off-label use. Dr. Fisher reports no conflict of interest. Drs. Lambiase, Gardner, and Altman are from the Department of Dermatology, San Antonio Uniformed Services Health Education Consortium, Fort Sam Houston, Texas, where Drs. Lambiase and Altman are Senior Dermatology Residents. Dr. Gardner is Associate Professor of Dermatology at the University of Texas at San Antonio. Dr. Albertini is a Mohs surgeon at the Skin Surgery Center, Winston-Salem, North Carolina.
The opinions or assertions expressed in this article are those of the authors and do not reflect the views of the US Army, US Air Force, or US Department of Defense.

CPT Matthew C. Lambiase, MC, USA; MAJ Timothy L. Gardner, MC, USA; CPT Coleman E. Altman, MC, USA; John G. Albertini, MD

Accepted for publication August 12, 2003. Drs. Lambiase, Gardner, and Altman are from the Department of Dermatology, San Antonio Uniformed Services Health Education Consortium, Fort Sam Houston, Texas, where Drs. Lambiase and Altman are Senior Dermatology Residents. Dr. Gardner is Associate Professor of Dermatology at the University of Texas at San Antonio. Dr. Albertini is a Mohs surgeon at the Skin Surgery Center, Winston-Salem, North Carolina.
The opinions or assertions expressed in this article are those of the authors and do not reflect the views of the US Army, US Air Force, or US Department of Defense.

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Bowen disease (BD) of the nail unit has multiple clinical presentations, often making its diagnosis challenging. BD is a squamous cell carcinoma (SCC) in situ with various cited etiologic causes, including ionizing and nonionizing radiation, hydrocarbon exposure, trauma, arsenic ingestion, chronic paronychia, ectodermal dysplasia, and dyskeratosis congenita.1-4 Human papillomavirus (HPV) has been associated with the pathogenesis of BD and SCC of the anogenital, oral, and periungual regions.3-9 Specifically, HPV-16 is well recognized as the predominant type associated with periungual BD and SCC, though HPV-34, -35, and -73 also have been identified.2-8 We describe the case of a 25-year-old African American man with BD of the third right fingernail presenting as longitudinal melanonychia (LM), in which HPV-56 DNA was identified. back to top


CASE REPORT A 25-year-old African American man presented to our dermatology service for evaluation of a pigmented streak of the third right fingernail that had been present for several years. Findings from the examination revealed a band of LM on the right third fingernail associated with overlying linear dystrophy of the nail plate. There was no periungual extension of pigmentation onto the adjacent cuticle or the lateral nail fold (Figure 1).


A 3-mm punch biopsy of the proximal nail matrix was performed and revealed acanthosis, hyperkeratosis, and full-thickness epidermal atypia (Figure 2). Hypergranulosis and koilocytic changes were noted (Figure 3). MART-1 (melanoma antigen recognized by T cells 1) staining demonstrated a normal number and distribution of melanocytes.
Polymerase chain reaction amplification, with subsequent hybridization with probes specific to the DNA of HPV, showed strong positivity for HPV-56. Mohs micrographic surgery was performed to excise the tumor with clear margins (Figure 4). The wound was primarily closed using a modified running winch stitch (Figure 5). An anogenital examination performed during follow-up was negative for any verrucous lesions. back to top


Comment BD of the nail unit commonly has been described as wartlike but may present as periungual erythema with associated crusting, ulceration or fissuring, paronychia, onychocryptosis, or nail dystrophy, with eventual partial to complete degeneration of the nail.1,10 The digits of the hands are more commonly involved than the feet.10 In most cases, a single digit is involved, with the thumb being the most common. More invasive disease should be suspected in nodular cases and when bleeding and ulceration occur.5,10 LM is another presentation of BD involving the nail unit first described by Baran and Simon11 in 1988.

Sass et al2 described the first case of BD presenting as LM, in which HPV-16 was identified, and further demonstrated genomic integration of the viral DNA in the chromosomal host DNA. HPV infection, especially type 16, has been implicated both in the pathogenesis of anogenital and oral BD2-4,7 and in the development of BD or invasive SCC in the periungual area.1-4,6 In addition, HPV-34, -35, and -73 have been described.4,7,8

HPVs related to mucosal or genital lesions likely play an important role in the pathogenesis of BD and invasive SCC in the periungual region.3,5,7 Guitart et al5 described a case in which similar HPV genomes were detected in a uterine cervical neoplasia and a subungual SCC in the same patient. Similarly, Rudlinger et al12 described a patient with HPV-35 positive bowenoid papulosis in the anogenital region who presented 11 years later with bowenoid dysplasia of a verruca on the right ring finger with the same HPV type. The presence of the same HPV type in both anogenital and periungual regions occurring in the same patient could be explained through autoinoculation or direct contact.1,3,5,7 This is consistent with the observation that extragenital BD lesions are found more commonly in the upper extremities.1,3,7

Lorincz et al13 first reported HPV-56 in 1989 after having been detected in invasive cervical cancers. HPV-56 is included in the high-risk group of HPV types often detected in either cervical intraepithelial neoplasia or invasive cancers, or both.3,9,13 In 1999, Uezato et al3 reported the first case in which HPV-56 was found in extragenital BD. The lesion occurred on the first great toe of an 81-year-old Japanese woman who subsequently underwent surgery, including skin grafting, without evidence of recurrence. To our knowledge, our case represents the second report in which HPV-56 was found in a case of extragenital BD.

The prognosis for patients with BD involving the nail unit is good. In the case of invasive carcinoma of the nail unit, the reported incidence of local bone invasion ranges from 18% to 60%.14-16 The high rate of local invasion may reflect a delay in diagnosis due to patient neglect and/or confusion regarding the clinical presentation. Metastatic disease is rare. However, it has been reported in 4 cases, one of which is a patient with hereditary ectodermal dysplasia.4,15,17,18

Surgical removal is the preferred therapeutic intervention, with either simple excision followed by skin graft or healing by secondary intention.1,10,19 Mohs micrographic surgery is the treatment of choice, allowing for complete removal of the tumor with maximal preservation of normal tissue and physiologic function.1,10,19

In conclusion, our case represents the first report of BD of the nail unit associated with HPV-56. As new HPV subtypes are identified and classified according to their oncogenic potential, the well-established association among high-risk HPV types in both anogenital and nail unit neoplasias is reinforced by these reports. Recognition of LM as a presenting sign of nail unit BD may result in early diagnosis and treatment. back to top

 

Bowen disease (BD) of the nail unit has multiple clinical presentations, often making its diagnosis challenging. BD is a squamous cell carcinoma (SCC) in situ with various cited etiologic causes, including ionizing and nonionizing radiation, hydrocarbon exposure, trauma, arsenic ingestion, chronic paronychia, ectodermal dysplasia, and dyskeratosis congenita.1-4 Human papillomavirus (HPV) has been associated with the pathogenesis of BD and SCC of the anogenital, oral, and periungual regions.3-9 Specifically, HPV-16 is well recognized as the predominant type associated with periungual BD and SCC, though HPV-34, -35, and -73 also have been identified.2-8 We describe the case of a 25-year-old African American man with BD of the third right fingernail presenting as longitudinal melanonychia (LM), in which HPV-56 DNA was identified. back to top


CASE REPORT A 25-year-old African American man presented to our dermatology service for evaluation of a pigmented streak of the third right fingernail that had been present for several years. Findings from the examination revealed a band of LM on the right third fingernail associated with overlying linear dystrophy of the nail plate. There was no periungual extension of pigmentation onto the adjacent cuticle or the lateral nail fold (Figure 1).


A 3-mm punch biopsy of the proximal nail matrix was performed and revealed acanthosis, hyperkeratosis, and full-thickness epidermal atypia (Figure 2). Hypergranulosis and koilocytic changes were noted (Figure 3). MART-1 (melanoma antigen recognized by T cells 1) staining demonstrated a normal number and distribution of melanocytes.
Polymerase chain reaction amplification, with subsequent hybridization with probes specific to the DNA of HPV, showed strong positivity for HPV-56. Mohs micrographic surgery was performed to excise the tumor with clear margins (Figure 4). The wound was primarily closed using a modified running winch stitch (Figure 5). An anogenital examination performed during follow-up was negative for any verrucous lesions. back to top


Comment BD of the nail unit commonly has been described as wartlike but may present as periungual erythema with associated crusting, ulceration or fissuring, paronychia, onychocryptosis, or nail dystrophy, with eventual partial to complete degeneration of the nail.1,10 The digits of the hands are more commonly involved than the feet.10 In most cases, a single digit is involved, with the thumb being the most common. More invasive disease should be suspected in nodular cases and when bleeding and ulceration occur.5,10 LM is another presentation of BD involving the nail unit first described by Baran and Simon11 in 1988.

Sass et al2 described the first case of BD presenting as LM, in which HPV-16 was identified, and further demonstrated genomic integration of the viral DNA in the chromosomal host DNA. HPV infection, especially type 16, has been implicated both in the pathogenesis of anogenital and oral BD2-4,7 and in the development of BD or invasive SCC in the periungual area.1-4,6 In addition, HPV-34, -35, and -73 have been described.4,7,8

HPVs related to mucosal or genital lesions likely play an important role in the pathogenesis of BD and invasive SCC in the periungual region.3,5,7 Guitart et al5 described a case in which similar HPV genomes were detected in a uterine cervical neoplasia and a subungual SCC in the same patient. Similarly, Rudlinger et al12 described a patient with HPV-35 positive bowenoid papulosis in the anogenital region who presented 11 years later with bowenoid dysplasia of a verruca on the right ring finger with the same HPV type. The presence of the same HPV type in both anogenital and periungual regions occurring in the same patient could be explained through autoinoculation or direct contact.1,3,5,7 This is consistent with the observation that extragenital BD lesions are found more commonly in the upper extremities.1,3,7

Lorincz et al13 first reported HPV-56 in 1989 after having been detected in invasive cervical cancers. HPV-56 is included in the high-risk group of HPV types often detected in either cervical intraepithelial neoplasia or invasive cancers, or both.3,9,13 In 1999, Uezato et al3 reported the first case in which HPV-56 was found in extragenital BD. The lesion occurred on the first great toe of an 81-year-old Japanese woman who subsequently underwent surgery, including skin grafting, without evidence of recurrence. To our knowledge, our case represents the second report in which HPV-56 was found in a case of extragenital BD.

The prognosis for patients with BD involving the nail unit is good. In the case of invasive carcinoma of the nail unit, the reported incidence of local bone invasion ranges from 18% to 60%.14-16 The high rate of local invasion may reflect a delay in diagnosis due to patient neglect and/or confusion regarding the clinical presentation. Metastatic disease is rare. However, it has been reported in 4 cases, one of which is a patient with hereditary ectodermal dysplasia.4,15,17,18

Surgical removal is the preferred therapeutic intervention, with either simple excision followed by skin graft or healing by secondary intention.1,10,19 Mohs micrographic surgery is the treatment of choice, allowing for complete removal of the tumor with maximal preservation of normal tissue and physiologic function.1,10,19

In conclusion, our case represents the first report of BD of the nail unit associated with HPV-56. As new HPV subtypes are identified and classified according to their oncogenic potential, the well-established association among high-risk HPV types in both anogenital and nail unit neoplasias is reinforced by these reports. Recognition of LM as a presenting sign of nail unit BD may result in early diagnosis and treatment. back to top

 

References

 

  1. Sau P, McMarlin ST, Sperling L, et al. Bowen’s disease of the nail bed and periungual area: a clinicopathologic analysis of seven cases. Arch Dermatol. 1994;130:204-209.
  2. Sass U, Andre J, Stene JJ, et al. Longitudinal melanonychia revealing an intraepidermal carcinoma of the nail apparatus: detection of integrated HPV-16 DNA. J Am Acad Dermatol. 1998;39:490-493.
  3. Uezato H, Hagiwara K, Ramuzi ST, et al. Detection of human papillomavirus type 56 in extragenital Bowen’s disease. Acta Derm Venereol. 1999;79:311-313.
  4. McHugh RW, Hazen P, Eliezri YD, et al. Metastatic periungual squamous cell carcinoma: detection of human papillomavirus type 35 RNA in the digital tumor and axillary lymph node metastases. J Am Acad Dermatol. 1996;34:1080-1082.
  5. Guitart J, Bergfeld WF, Tuthill RJ, et al. Squamous cell carcinoma of the nail bed: a clinicopathological study of 12 cases. Br J Dermatol. 1990;123:215-222.
  6. Kawashima M, Jablonska S, Favre M, et al. Characterization of a new type of human papillomavirus found in a lesion of Bowen’s disease of the skin. J Virol. 1986;57:688-692.
  7. Mitsuishi T, Sata T, Matsukura T, et al. The presence of mucosal human papillomavirus in Bowen’s disease of the hands. Cancer. 1997;79:1911-1917.
  8. Moy RL, Eliezri YD, Nuovo GJ, et al. Human papillomavirus type 16 DNA in periungual squamous cell carcinomas. JAMA. 1989;261:2669-2673.
  9. Schiffman MH, Kiviat NB, Burk RD, et al. Accuracy and interlaboratory reliability of human papillomavirus DNA testing by hybrid capture. J Clin Microbiol. 1995;33:545-550.
  10. Mikhail GR. Subungual epidermoid carcinoma. J Am Acad Dermatol. 1984;11:291-298.
  11. Baran R, Simon C. Longitudinal melanonychia: a symptom of Bowen’s disease. J Am Acad Dermatol. 1988;18:1359-1360.
  12. Rudlinger R, Grob R, Yu YX, et al. Human papillomavirus-35-positive bowenoid papulosis of the anogenital area and concurrent human papillomavirus-35-positive verruca with bowenoid dysplasia of the periungual area. Arch Dermatol. 1989;125:655-659.
  13. Lorincz AT, Quinn AP, Goldsborough MD, et al. Human papillomavirus type 56: a new virus detected in cervical cancers. J Gen Virol. 1989;70:3099-3104.
  14. Lumpkin LR, Rosen T, Tschen JA. Subungual squamous cell carcinoma. J Am Acad Dermatol. 1984;11:735-738.
  15. Campbell CJ, Keokarn T. Squamous cell carcinoma of the nail bed in epidermal dysplasia. J Bone Joint Surg. 1966;48:92-99.
  16. Long PI, Espiniella JL.
References

 

  1. Sau P, McMarlin ST, Sperling L, et al. Bowen’s disease of the nail bed and periungual area: a clinicopathologic analysis of seven cases. Arch Dermatol. 1994;130:204-209.
  2. Sass U, Andre J, Stene JJ, et al. Longitudinal melanonychia revealing an intraepidermal carcinoma of the nail apparatus: detection of integrated HPV-16 DNA. J Am Acad Dermatol. 1998;39:490-493.
  3. Uezato H, Hagiwara K, Ramuzi ST, et al. Detection of human papillomavirus type 56 in extragenital Bowen’s disease. Acta Derm Venereol. 1999;79:311-313.
  4. McHugh RW, Hazen P, Eliezri YD, et al. Metastatic periungual squamous cell carcinoma: detection of human papillomavirus type 35 RNA in the digital tumor and axillary lymph node metastases. J Am Acad Dermatol. 1996;34:1080-1082.
  5. Guitart J, Bergfeld WF, Tuthill RJ, et al. Squamous cell carcinoma of the nail bed: a clinicopathological study of 12 cases. Br J Dermatol. 1990;123:215-222.
  6. Kawashima M, Jablonska S, Favre M, et al. Characterization of a new type of human papillomavirus found in a lesion of Bowen’s disease of the skin. J Virol. 1986;57:688-692.
  7. Mitsuishi T, Sata T, Matsukura T, et al. The presence of mucosal human papillomavirus in Bowen’s disease of the hands. Cancer. 1997;79:1911-1917.
  8. Moy RL, Eliezri YD, Nuovo GJ, et al. Human papillomavirus type 16 DNA in periungual squamous cell carcinomas. JAMA. 1989;261:2669-2673.
  9. Schiffman MH, Kiviat NB, Burk RD, et al. Accuracy and interlaboratory reliability of human papillomavirus DNA testing by hybrid capture. J Clin Microbiol. 1995;33:545-550.
  10. Mikhail GR. Subungual epidermoid carcinoma. J Am Acad Dermatol. 1984;11:291-298.
  11. Baran R, Simon C. Longitudinal melanonychia: a symptom of Bowen’s disease. J Am Acad Dermatol. 1988;18:1359-1360.
  12. Rudlinger R, Grob R, Yu YX, et al. Human papillomavirus-35-positive bowenoid papulosis of the anogenital area and concurrent human papillomavirus-35-positive verruca with bowenoid dysplasia of the periungual area. Arch Dermatol. 1989;125:655-659.
  13. Lorincz AT, Quinn AP, Goldsborough MD, et al. Human papillomavirus type 56: a new virus detected in cervical cancers. J Gen Virol. 1989;70:3099-3104.
  14. Lumpkin LR, Rosen T, Tschen JA. Subungual squamous cell carcinoma. J Am Acad Dermatol. 1984;11:735-738.
  15. Campbell CJ, Keokarn T. Squamous cell carcinoma of the nail bed in epidermal dysplasia. J Bone Joint Surg. 1966;48:92-99.
  16. Long PI, Espiniella JL.
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