A 26-year-old-women, with a history of cutaneous Rosai Dorfman disease treated with oral corticosteroids and methotrexate, presented with a 5 months history of multiple gray-brown papules and small well-defined patches located symmetrically on her vulval labia and around the anus (Figure 1). Genital warts, a verrucous nevus and Bowen disease were suspected among our clinical diagnosis. The dermoscopy revealed a pigmented papillomatous surface, brown-gray dots arranged in a linear distribution, grey-brown structureless areas and widespread dotted and glomerular vessels (Figure 2). A punch biopsy was done, and the histology showed highly atypical squamous cells accompanied by cytological atypia and mitosis with multiple koilocyte, consistent with the diagnosis of bowen disease. The patient was treated with topical 5-fluorouracil once daily for four weeks.

Keywords: Bowen disease; Vulvar; Dermoscopy.