Extramammary Paget's Disease of Vulva Vs Bowen?s Disease of Vulva - A Clinical Dilemma

Background: Extramammary Paget's disease of the vulva is a rare intraepithelial adenocarcinoma. [1, 2] Bowen's disease of the vulva represents squamous cell carcinoma in situ, characterized by full-thickness dysplasia of the vulvar epithelium without invasion. [3] Preoperative diagnosis is challenging, and histopathological examination along with immunohistochemistry is the gold standard for diagnosis. We present a case of a 49-year-old woman with a vulval lesion with differential diagnosis of Vulval Pagets or Bowens disease. Methods: Investigations like HPV viral load, with punch biopsy was done and the final diagnosis was confirmed through histopathology with immunohistochemistry. The patient underwent Wide local excision and was followed up. Results: The patient's final diagnosis was confirmed by histopathology and immunohistochemistry, showing features characteristic of bowens disease of vulva. The patient recovered well post-surgery. Conclusion: This case highlights the difficulty in differentiating a vulval lesion preoperatively as Vulval Pagets or Bowens disease and emphasizes the importance of histopathological and immunohistochemistry evaluation for confirmation.