The group related to human papillomavirus (HPV) type 16 (HPV-16, -31, -33, -35, -52, -58 and -67) is dominantly identified in cervical intraepithelial neoplasia and cervical carcinomas. HPV-16 has also been frequently detected in Bowen’s disease on the hands and feet. We describe herein a case of polydactylous Bowen’s disease on the fingers and toes of a woman who had had radical vulvectomy and hysterectomy for concomitant invasive vulval and cervical carcinomas. All the lesions, except for the lesions on the periungual side of her left index, middle and ring fingers, harbored HPV-58 DNA with more than 100 entire viral genome copies per cell detected by Southern blot hybridization. The histological localization of the viral DNA was confirmed in all the lesions by in situ hybridization. We could also retrospectively demonstrate HPV-58 DNA in her invasive vulval and cervical carcinoma tissues.

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A woman with Hailey-Hailey disease, suffering from carcinoma of the vulva, was examined by histology and for the presence of human papillomavirus (HPV) DNA by polymerase chain reaction (PCR) and in situ hybridization. Our diagnosis by histological examination revealed the vulval carcinoma to be a squamous cell carcinoma (SCC), adjacent to lesions of Hailey-Hailey disease and severe dysplasia/carcinoma in situ [vulval intraepithelial neoplasia (VIN) III]. The PCR with consensus primers for the L1 region (L1-PCR) successfully amplified HPV DNA using total DNA extracted from formalin-fixed and paraffin-embedded tissue specimens. Restriction fragment length polymorphism analysis and sequencing of L1-PCR products revealed HPV types 16 and 39. HPV 16-specific primers for the E6 region identified HPV 16 DNA. In situ hybridization analysis with biotinylated HPV 16 and 39 DNA probes revealed the presence of the HPV 39 genome in the nuclei of the tumour cells in the SCC. These results indicate that HPV 16 and 39 are associated with lesions in vulval carcinoma. Regarding the patient's susceptibility to infection in the case of Hailey-Hailey disease, there is a possibility that HPV was inoculated into the lesions of Hailey-Hailey disease and induced those of VIN III and SCC.

We describe an 86-year-old man with Bowen's disease on the pubic area. The lesion was clinically a black-brownish keratotic nodule resembling seborrheic keratosis. Histopathological findings showed those of Bowen's disease and harboured human papillomavirus type 34 DNA. Genital, but not skin, human papillomaviruses are responsible for Bowen's disease on the skin.

Sir,Recent studies have identified various types of human papillomavirus (HPV) in Bowen's disease (BD) on the hands and feet, especially at periungual and subungual sites (1, 2). BD represents a squamous cell carcinoma in situ. HPV 16 and other 'high risk' types have frequently been identified as in genital BD. Only two cases of BD on the web-spaces of the foot have been reported (3, 4). We describe a case of BD arising in the web-space of the foot associated with HPV 16. CASE REPORTA 33-year-old Japanese man had observed a brownish macule on his left foot for 1 year. He had previously been treated for tinea pedis with topical antifungal agents. Physical examination revealed a brownish, relatively well demarcated macule, 763 mm in diameter, in the web-space between the third and fourth toes of his left foot (Fig. 1a). A skin-coloured, keratotic papule was observed adjacent to the brownish macule. He had no history of genital disorders such as bowenoid papulosis or condyloma acuminatum. Histopathological examination of a skin biopsy revealed proliferation of irregularly arranged atypical keratinocytes throughout the epidermis, hyperkeratosis with dyskeratotic, clumping cells and mitotic figures (Fig. 1b). A diagnosis of BD was made. FontanaMasson staining showed an increased amount of melanin in the basal layer and numerous pigment-filled dendritic melanocytes in the lesion. Melanophages were also prominent in the upper dermis. The HPV capsid antigen was detected by immunohistochemical analysis (K1H8, Dako, Kyoto, Japan). Southern blot hybridization was employed to detect HPV DNA and determine the HPV genotype. The cleavage patterns of the lesion were similar to those of prototype HPV 16 (Fig. 1c). The lesion was surgically removed and no relapse was observed after 1 year. DISCUSSIONOur case is clinically characterized by a very small, brownish and keratotic macule on the web-space of the patient's left foot. Histopathological findings were compatible with those of BD. Pigmentation was caused by the presence of pigment-filled melanocytes, a large amount of melanin in the basal layer and prominent melanophages in the upper dermis. HPV 16 DNA was identified in the lesion.Over 90 HPV genotypes have been characterized. HPV 16 was first found in extragenital BD in 1983 (5), and subsequently also in BD of the hands and feet (2). a b c Fig. 1. (a) Well-demarcated pigmented macule in the web-space between the third and fourth toes of the left foot. (b) Proliferated atypical keratinocytes throughout the epidermis, with hyperkeratosis, dyskeratotic cells, clumping cells and mitotic figures (haematoxylineosin stain; original magnification 6100). (c) Detection of human papillomavirus 16 DNA in the lesion by Southern blot hybridization. The DNA was digested with several restriction enzymes: PstI (P), BanI (B) and MspI (M).