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Penile Carcinoma in Situ

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Penile Carcinoma in Situ, Penile Cancer in Situ, Penile Erythroplasia of Queyrat, Bowen Disease of the Penis, Carcinoma in Situ of Penis

  • Epidemiology
  1. Occurs in uncircumsized men over age 60 years
  • Causes
  1. Genital Warts due to HPV infection (key causative factor)
  2. Local Trauma from heat, friction or inflammation
  • Symptoms
  1. Asymptomatic in 50% of men (other than the lesions being present)
  2. Pain
  3. Pruritus
  • Signs
  1. Velvet-like Plaques on glans penis (Erythroplasia of Queyrat)
    1. Raised, beefy red irregularly shaped Plaques
      1. May be crusted, non-red lesions in uncircumsized patients
    2. Ulceration may occur
    3. Range in size from 0.2 cm up to 3.5 cm
    4. Distributed on the glans penis, Urethral meatus, coronal sulcus and foreskin
  2. Keratotic Plaques (Bowen Disease)
    1. Occur on penile shaft, scrotal skin, perineum
  • Labs
  • Biopsy
  1. Biopsy all suspicious lesions
  • Management
  1. Surgery
    1. Mohs Micrographic Surgery
    2. Circumcision if the lesion is isolated to the foreskin
  2. Topical agents have been used with varying success (5-FU, curettage, laser ablation, Aldara)
    1. Most topical treatments are associated with recurrence
  3. Radiation Therapy
    1. Consider in non-surgical candidates
  • Differential Diagnosis
  1. Psoriasis
  2. Zoon Balanitis
  • Complications
  1. Progresses to invasive Penile Squamous Cell Carcinoma in 5-30% of patients
  • References
  1. Gerber (1994) J Urol 151(4): 829-33 [PubMed]
  2. Teichman (2010) Am Fam Physician 81(2): 167-74 [PubMed]
  3. Teichman (2018) Am Fam Physician 97(2): 102-10 [PubMed]