Bowenoid Surprises

In this talk, the speaker discusses two intriguing cases of squamous cell carcinoma in situ (SCCIS), often referred to as Bowen disease, emphasizing the complexities and controversies surrounding its classification and diagnosis. The speaker has transitioned away from using the term "Bowen's disease" due to varying interpretations among clinicians regarding its implications. The discussion highlights the speaker's preference for using traditional H&E stains over immunostains, contrasting their practice with a high-volume lab that utilizes extensive immunostaining, leading to substantial pathology bills. The cases presented illustrate challenging diagnoses characterized by pagetoid features, which can mimic Paget's disease, and involve immunostains that complicate histopathological interpretation. One case, diagnosed as squamous cell carcinoma in situ, demonstrates questionable invasive characteristics, while the second case hints at a neuroendocrine component. Ultimately, the speaker posits that many of the peculiar staining results, while interesting, may not significantly affect patient outcomes, reinforcing the perspective that excessive reliance on immunostains could obfuscate rather than clarify diagnoses. The overarching message is that despite these diagnostic challenges, these squamous cell carcinomas live within identifiable parameters, and understanding their essence does not necessitate immunostain usage.