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Digital Bowen Disease — SCE Dermatology MCQ

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HardSkin CancerDigital Bowen DiseaseSCE Dermatology

A renal-transplant recipient has a persistent verrucous periungual plaque that repeatedly failed wart treatment; biopsy shows squamous cell carcinoma in situ. Which viral association is most relevant at this site?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — High-risk HPV16 with assessment for digital or anogenital disease

Explanation lettering: E = shown as C · C = shown as E

A is correct. The BAD guideline identifies HPV16 as particularly relevant to palmoplantar and periungual SCC in situ; immunosuppression further increases HPV detection. Genital-digital spread is proposed, so examination and history should consider disease at both sites without implying that every patient has anogenital neoplasia. HPV6 is mainly a low-risk wart type, HPV1 causes common plantar warts, and HPV3 is associated with flat warts. Molluscum contagiosum virus does not drive SCC in situ. A chronic “wart” in an immunosuppressed patient therefore warrants biopsy rather than repeated destructive treatment.

Reference: BAD cutaneous SCC in situ guideline 2022: https://academic.oup.com/bjd/article/188/2/186/6788751