Scientific Online Resource System

Scripta Scientifica Medica

Disseminated superficial actinic porokeratosis, Bowen's disease and basal cell carcinoma. Coincidence or rare double malignant transformation?

Todor Yordanov, Elisaveta Popchristova, Neli Koleva, Irina Yungareva, Jenya Dimitrova, Sonya Marina


Disseminated superficial actinic porokeratosis (DSAP) is a skin condition that consist of multiple annular, hyperkeratotic lesions. They are usually distributed bilaterally and mostly affect the extremities. DSAPs have a wider distribution than the porokeratosis of Mibelli and usually appears between the age of 40 and 50. Squamous cell carcinoma, Bowen’s disease, and basal cell carcinoma that arises in the classical type of porokeratosis of Mibelli is well-documented, but there are not many reported cases of Bowen’s disease and basal cell carcinoma arising in DSAP. We present a 77-year-old woman in whom the two– Bowen’s disease and Basal cell carcinoma develop in a histologically proven DSAP. 


disseminated superficial actinic porokeratosis; squamous cell carcinoma; Bowen’s disease; basal cell carcinoma

Full Text


Biswas A. Cornoid lamellation revisited: apropos of porokeratosis with emphasis on unusual clinicopathological variants. Am J Dermatopathol. 2015;37(2):145-55. doi: 10.1097/DAD.0000000000000039.

Fernandez-Flores A. Small lesions of porokeratosis show a normal proliferation rate with MIB-1. Acta Dermatovenerol Alp Pannonica Adriat. 2008;17(1):22-5.

Kamata Y, Maejima H, Watarai A, Saito N, Katsuoka K, Takeda A, et al. Expression of bleomycin hydrolase in keratinization disorders. Arch Dermatol Res. 2012 ;304(1):31-8. doi: 10.1007/s00403-011-1180-6.

Ma Y, Li C, Wu J, Cui P, Lin L, Feng S. Coexistence of porokeratosis ptychotropica with porokeratosis of Mibelli in a Chinese man. Postepy Dermatol Alergol. 2015;32 (4):307-9. doi: 10.5114/pdia.2015.53324.

Shumack SP, Commens CA. Disseminated superficial actinic porokeratosis: a clinical study. J Am Acad Dermatol. 1989;20(6):1015–22. doi: 10.1016/s0190-9622(89)70126-2.

Yang HY, Nam TS, Kim YT, Kim JH. A case of squamous cell carcinoma and Bowen's disease associated with superficial disseminated porokeratosis. Ann Dermatol. 1990; 2:31–4.

James WD, Rodman OG. Squamous cell carcinoma arising in porokeratosis of Mibelli. Int J Dermatol. 1986;25(6):389-91. doi: 10.1111/j.1365-4362.1986.tb03430.x.

Sasson M, Krain AD. Porokeratosis and cutaneous malignancy. A review. Dermatol Surg. 1996;22(4):339-42. doi: 10.1111/j.1524-4725.1996.tb00327.x.

Seishima M, Izumi T, Oyama Z, Maeda M. Squamous cell carcinoma arising from lesions of porokeratosis palmaris et plantaris disseminata. Eur J Dermatol. 2000;10(6):478-80.

Leow YH, Soon YH, Tham SN. A report of 31 cases of porokeratosis at the National Skin Centre. Ann Acad Med Singapore.1996;25(6):837-41.

Sertznig P, von Felbert V, Megahed M. Porokeratosis: present concepts. J Eur Acad Dermatol Venereol. 2012;26(4):404-12. doi: 10.1111/j.1468-3083.2011.04275.x.

Jang KA,Choi JH, Sung KJ, Moon KC, Koh JK.. The hyperkeratotic variant of disseminated superficial actinic porokeratosis (DSAP). Int J Dermatol.1999;38(3):204-6. doi: 10.1046/j.1365-4362.1999.00657.x.

Ninomiya Y, Urano Y, Yoshimoto K, Iwahana H, Sasaki S, Arase S, et al. p53 gene mutation analysis in porokeratosis and porokeratosis-associated squamous cell carcinoma. J Dermatol Sci. 1997;14(3):173–8. doi: 10.1016/s0923-1811(96)00569-5.

Magee JW, McCalmont TH, Leboit PE. Overexpression of p53 tumor suppressor protein in porokeratosis. Arch Dermatol. 1994;130(2):187-90.

Lozinski AZ, Fisher BK, Walter JB, Fitzpatrick PJ. Metastatic squamous cell carcinoma in linear porokeratosis of Mibelli. J Am Acad Dermatol. 1987;16(2 Pt 2):448–51. doi: 10.1016/s0190-9622(87)70059-0.

Taylor AM, Hamden DG, Fairburn EA. Chromosomal instability associated with susceptibility to malignant disease in patients with porokeratosis of Mibelli. J Natl Cancer Inst. 1973;51(2):371-8.

Maubec E, Duvillard P, Margulis A, Bachollet B, Degois G, Avril MF. Common skin cancers in porokeratosis. Br J Dermatol. 2005;152(6):1389-91. doi: 10.1111/j.1365-2133.2005.06639.x.

Leache A, Soto de Delás J, Vázquez Doval J, Lozano MD, Quintanilla E. Squamous cell carcinoma arising from a lesion of disseminated superficial actinic porokeratosis. Clin Exp Dermatol. 1991;16(6):460–2. doi: 10.1111/j.1365-2230.1991.tb01237.x.

Otsuka F, Umebayashi Y, Watanabe S, Kawashima M, Hamanaka S. Porokeratosis large skin lesions are susceptible to skin cancer development: histological and cytological explanation for the susceptibility. J Cancer Res Clin Oncol. 1993;119(7):395-400. doi: 10.1007/BF01218420.

About The Authors

Todor Yordanov
Department of Skin and Venereal Diseases Medical Institute of the Ministry of Internal Affairs

Elisaveta Popchristova
Department of Clinical Pathology Medical Institute of the Ministry of Internal Affairs

Neli Koleva
Department of Clinical Pathology Medical Institute of the Ministry of Internal Affairs

Irina Yungareva
Department of Skin and Venereal Diseases Medical Institute of the Ministry of Internal Affairs

Jenya Dimitrova
Medical University of Varna

Department of Infectious Diseases, Parasitology and Dermatovenereology, Faculty of Medicine

Sonya Marina
Department of Skin and Venereal Diseases Medical Institute of the Ministry of Internal Affairs

Font Size