Bowen's disease complicated by SCC

Age: 75 years
Gender: female
Site: back
Duration: > 5 years
History:
* Russian woman living in IRAQ since many decades
* Asymptomatic red plaque
Findings:
* Giant red infiltrative well demarcated plaque
* Dome-shaped red nodule, about 1 cm in diameter, in the center of unknown duration! (see the black arrow)
Investigations: two biopsies were taken; first one from the plaque and second one was deep taking the entire nodule.
Results:
First biopsy showed Bowen's disease
Second biopsy revealed SCC reaching the lower dermis
Treatment: referred to the oncology department