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BACKGROUND: This article describes the clinical and histologic features of seven cases of Bowen's disease (BD) of the nail bed, evaluates the role of human papillomavirus in the bowenoid change, and discusses optimal therapy. OBSERVATION: The patients presented with the clinical features of verruca vulgaris (n=3), nail dystrophy and onycholysis (n=2), paronychia (n=1), and acral melanoma (n=1). Histologically, the lesions demonstrated acanthosis, hyperkeratosis, and anaplasia, involving the full thickness of the epithelium. In four cases, human papillomavirus type 16 was demonstrated by in situ hybridization. Six lesions were treated by Mohs micrographic surgery, and one case was treated with topical 5% fluorouracil. In two cases, lesions recurred 1 and 2 years following surgery. In the case treated with topical 5% fluorouracil, residual BD was found 6 weeks after therapy. This case was then treated by Mohs surgery. CONCLUSIONS: Bowen's disease of the nail bed and periungual area may present clinically as various inflammatory and neoplastic conditions. An important clinical finding in differentiating BD of the nail bed from verruca is the presence of scaling and onycholysis that are out of proportion to the verrucous changes. Human papillomavirus type 16 may be etiologically related to BD of the nail bed and periungual area. Mohs micrographic surgery is recommended for adequate excision and maximal preservation of normal tissue and function.(Arch Dermatol. 1994;130:204-209)

• Microcystic adnexal carcinoma is a recently described neoplasm characterized by a locally aggressive growth pattern. The tumor usually affects the upper lip of middle-aged women, but occurs in other facial areas and in men. Histologically, a distinctive combination of keratin-filled cysts, islands and strands of basaloid and squamous cells, and ducts and glandlike structures is seen. A dense, hyalinized stroma is also a feature as well as frequent perineural invasion by tumor cells. While microcystic adnexal carcinoma is deeply infiltrating in its growth, metastasis has not been reported. However, recurrences with extensive local tumor spread are often observed. We describe a middle-aged man who initially had a lesion of microcystic adnexal carcinoma excised 30 years prior to definitive treatment for a recurrence at the original site. To our knowledge, this is the longest follow-up of a patient with microcystic adnexal carcinoma and confirms its locally infiltrating, indolent biologic behavior.(Arch Dermatol 1986;122:286-289)

• A case of verrucous carcinoma occurred on the face of a patient and prompted a review of the literature on this disorder. It is difficult to make a histopathologic diagnosis in such cases.(Arch Dermatol 1984;120:383-385)

Striae distensae are wide, linear bands occurring on the body that, until recently, were of uncertain origin. One of four possible etiologic mechanisms usually considered were: (1) insufficient development of the integuement, including a deficiency in its elastic properties; (2) rapid stretching of the skin; (3) endocrine imbalance; and (4) other, possibly toxic, causes.1 General support for each of these mechanisms were reported in the literature over the years.2-5 By the mid-20th century, however, it was believed that endocrine imbalance was probably the most important causative factor.3,510 Mechanical and other factors also caused some secondary effects.Multiple names were given to identify this condition— "striae atrophicae," "striae distensae," and "lineae atrophicae."11 Striae distensae found the most common acceptance.8,11 The lesions are described as depressed or elevated bands or lines on the body having a change in color or texture.8 The lesions generally follow cleavage