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PubMed1990

[Plasmocellular balanoposthitis of Zoon].

Plasma cell balinitis of Zoon is a well-defined and easily-recognized disease entity that is little-known in urology. Our clinical experience in 5 cases is reported herein. The uncommon presentation of this condition in a 12-year-old patient is underscored. The clinical picture, gross features of the typical erythroplastic plaque, the differential diagnosis with special reference to Queyrat's erythroplasia, and the characteristic histologic features are described. Our experience confirms the inefficacy of topical treatment with antiseptic agents and corticosteroids. Circumcision is still the only effective treatment of this disease.

Adrenal Cortex Hormones↗

PubMedDate not supplied

[Carcinoma of the penis: review of our cases].

A review is made of 36 carcinomas of the penis treated in the Urology Department of the "La Fe" Hospital. The most frequent decade for their appearance is the fifties. We establish their link with restricted hygiene and with fimosis, Queyrat's erythroplasia, leukoplasia and accuminated condyloma. The treatment given depends essentially on the clinical stage. We feel that within stage A, with minimum prepuce lesions, the ideal treatment is local excision and circumcision plus radiotherapy; in the case of minimal gland lesions radiotherapy; in the rest and when the former forms of therapy fail, partial amputation of the penis. We currently treat this stage with cryosurgery although we cannot give any results because of the limited period of development of the same. In stage B, we indicate amputation plus bilateral, ilio-inguinal lymphadenectomy plus radiotherapy. In stages C and D the treatment is palliative, on the basis of polychemotherapy.

Adult↗

PubMed1986

Plasma cell orificial mucositis. Report of a case and review of the literature.

Plasma cell orificial mucositis is a benign idiopathic condition of orificial mucous membranes, characterized histopathologically by a dense plasmacytic infiltrate. Although plasma cell orificial mucositis was originally described by Zoon as occurring on the glans penis, conditions similar to plasma cell orificial mucositis involving other body orifices have been reported under various names. A patient with involvement of the lips and epiglottis associated with psoriasis and fissured tongue is described. Plasma cell orificial mucositis must be differentiated from numerous other entities, including erythroplasia of Queyrat, allergic contact mucositis, plasmacytoma, plasmoacanthoma, syphilis, candidiasis, and cheilitis granulomatosa.

Female↗

PubMed1998

Absence of p53 mutations in benign and pre-malignant male genital lesions with over-expressed p53 protein.

Mutations of the tumor-suppressor gene p53 are common in epithelial tumors. Clonal mutations of p53 have been found in cervical and vulvar carcinomas negative for human papillomavirus (HPV), though at least in cervical cancer HPV infection and p53 mutations are not mutually exclusive. We have previously shown that about 40% of male genital warts and bowenoid papulosis lesions exhibit immunohistochemically detectable aberrant p53 protein, irrespective of the presence of HPV DNA. We studied p53 mutations in exons 4-8 with SSCP and sequencing in 13 male patients with 1 to 3 therapy-resistant genital warts or intra-epithelial neoplasias each and in 4 patients with penile squamous cell carcinoma. Thus, 13 genital warts, 6 bowenoid papulosis, 1 Queyrat's erythroplasia and 1 carcinoma in situ were studied. p53 protein was detected immunohistochemically, and HPV status was analyzed with DNA in situ hybridization and amplification of HPV-specific DNA. There was no correlation between p53 protein expression and HPV status. No mutations in exons 5-8 of the p53 gene were found in any of the lesions, and furthermore, no exon 4 mutations were found in lesions positive in p53 immunohistochemistry. In conclusion, overexpression of p53 does not indicate a p53 mutation in male genital warts, pre-malignant lesions or malignant squamous cell carcinomas. Our study thus suggests that p53 mutations are not important, or at least not early, events in male genital carcinogenesis.

Biopsy↗

PubMed1984

Oral leukoplakia and malignant transformation. A follow-up study of 257 patients.

Two hundred fifty-seven patients with oral leukoplakia were studied and followed for an average period of 7.2 years. All lesions were more than one cm in size and had been present and observed for a minimum of 6 months. Of the initial biopsies, 235 revealed a benign hyperkeratosis and 22 others contained some degree of epithelial dysplasia. Seventy-three percent of the patients used tobacco, with cigarette usage being the predominant form. Forty-five patients (17.5%) subsequently developed squamous carcinomas in the hyperkeratotic epithelial site in an average time of 8.1 years. Eight of these malignant transformations came from patients who originally had epithelial dysplasia. High risks for malignant transformation also included non-smoking patients, the clinical presence of erythroplasia (erythroleukoplakia), and a clinical verrucous-papillary hyperkeratotic pattern. Duration of the leukoplakia progressively increased the total number of malignant transformations, with the largest rate occurring in the second year. This study confirms that oral leukoplakia is a precancerous lesion and that certain characteristics indicate greater risks and warrant consideration of more aggressive management.

Adult↗

PubMed1989

Appearance, site of occurrence, and physical and clinical characteristics of oral carcinoma in Torino, Italy.

The appearance, site of occurrence, and selected physical and clinical characteristics are reported for 102 symptomatic carcinomas diagnosed during a 30-month period in Torino, Italy. Erythroplasia was a more significant visual component than leukoplakia, confirming the results of a previous study on asymptomatic cancer in a US population. Floor of the mouth, oral tongue, and soft palate complex accounted for 75% of all sites and 84% of sites if posterior pillar is excluded. Seventeen percent of the lesions were T1, 60% T2, and 23% larger than T2. Size of the lesion was associated with anterior or posterior position and the mobility of the structure, as well as with ulceration, bleeding, and lymphadenopathy (55% of cancers had no nodal involvement). Tumefaction, burning, and pain were the most frequently reported symptoms. About 50% of patients experienced a time lapse between onset of symptoms and final diagnosis of less than 3 months, and this proportion was higher among patients with T1 cancers.

Adult↗

PubMed2002

Radiotherapy of skin tumors.

The incidence of cancers of the skin is increasing, as is life expectancy among most of the population. Besides surgery, all skin cancers can be treated with radiotherapy, with excellent results. Unfortunately, both less training and less equipment are available than earlier, which means that dermatologists also have less experience in this field. We would like to propose radiotherapy for medium-sized or larger lesions, especially on the face in elderly people. Good indications are keratoacanthomas, extensive actinic keratoses, Bowen's disease including erythroplasia of Queyrat, basal cell and squamous cell carcinomas, but also lentigo maligna and lentigo maligna melanomas. These tumors can be treated in a curative way. Excellent results of palliative X-ray therapy are achieved in Kaposi's sarcoma and in lymphomas, and also in Merkel cell tumors. After 100 years of treatment of skin cancers by radiotherapy, dermatologists should not forget that if appropriate principles are followed and precautions are taken, X-ray treatment is still a safe and effective method.

Dose Fractionation, Radiation↗

PubMed2001

[Clinical aspects and therapy of anogenital warts and papillomavirus-associated lesions].

There is a series of different therapies for the treatment of anogenital warts. Home therapy should be reserved only for initial therapy of simple cases. Such approaches include podophyllotoxin solution, podophyllotoxin cream,imiquimod cream and adjuvant interferon gel. Recurrent disease and disseminated disease must be treated by the physician. Choice of therapy depends on the morphology, the extent of the disease and also on the immunological status of the patient. Therapy should be discussed between the physician and the patient. Whatever therapy will be chosen, HPV DNA can persist latently in surrounding tissue and may lead to recurrence of visible lesions. Long-standing warts can undergo malignant conversion; intraepithelial neoplasias such as Bowen's disease, erythroplasia of Queyrat and bowenoid papulosis are especially prone to develop into squamous-cell carcinoma. Thus adequate therapy and thorough follow-up are mandatory in such cases. In the future therapies directed against HPV specifically will be available. They should lead both to destruction and complete clearance of visible lesions and also should prevent recurrences. Ideally HPV should be eliminated completely from the treated tissue.

Adjuvants, Immunologic↗

PubMed2003

Role of human papillomavirus in penile cancer, penile intraepithelial squamous cell neoplasias and in genital warts.

Using PCR, the overall prevalence of human papillomavirus (HPV) DNA in penile carcinoma is about 40-45%, which is similar to the detection rate of HPV-DNA in vulvar carcinoma (50%). In analogy to vulvar cancer two different pathways of penile carcinogenesis seem to exist. In contrast to basaloid and warty penile cancers which are regularly HPV-associated (about 80-100%), only a part of keratinizing and verrucous penile carcinomas appear to be related with HPV (33-35%). Penile intraepithelial neoplasias comprising Bowen's disease, erythroplasia of Queyrat and bowenoid papulosis are precursor lesions of basaloid and warty carcinomas of the penis. Precursors of keratinizing carcinomas and verrucous carcinomas are not established. Whether lichen sclerosus and squamous-cell hyperplasia precede penile keratinizing carcinoma is a matter of discussion. Giant condylomata acuminata may precede the development of verrucous carcinomas in some cases. Since high risk HPVs are more frequently found in verrucous carcinomas than in giant condylomas, HPV typing may be a helpful diagnostic step to differentiate giant condyloma from verrucous carcinoma.

Carcinoma in Situ↗

PubMed1984

Papulosquamous lesions of glans penis.

The presentation of a scaly papule or plaque on the glans penis should suggest more wide-spread papulosquamous disease. Careful examination of the remaining body surface, including the oral mucosa and nails, in almost all cases will yield clues to the correct diagnosis. Papulosquamous disease which may present as a penile lesion include psoriasis, Reiter syndrome, lichen planus, lichen nitidus, seborrheic dermatitis, secondary syphilis, fixed drug eruption, erythroplasia of Queyrat, plasma cell balanitis of Zoon, bowenoid papulosis, and discoid and lichenoid chronic dermatosis of Sulzberger and Garbe.

Adult↗

PubMed1988

Bowenoid papulosis of the penis: successful management with neodymium:YAG laser.

Bowenoid papulosis of the penis is a recently described entity that clinically resembles benign verruca-like papular lesions but, histologically, it is identical to carcinoma in situ, Bowen's disease or erythroplasia of Queyrat. Although a few cases of spontaneous regression of bowenoid papulosis in men have been reported, conservative therapy, consisting of topical 5-fluorouracil, electrodissection or excision, is recommended. With these treatment modalities recurrences are not uncommon. We report 2 cases of extensive bowenoid papulosis of the penis treated successfully without scarring with the neodymium-yttrium-aluminum-garnet laser.

Adult↗

PubMed1998

Cancer precursors.

A significant proportion of cutaneous malignancies arise from well-defined precursor lesions that have often been present for many years. This provides an opportunity to reduce rates of skin cancer by recognition and treatment of these lesions. Precursors of keratinocytic malignancy, such as actinic keratoses and Bowen's disease, are extremely common in the older, white population and will frequently be encountered by generalist physicians in the context of examinations for noncutaneous conditions. Less common conditions, such as erythroplasia of Queyrat and nevus sebaceous, are associated with a higher risk of malignant change, and their recognition is therefore imperative. The management of the various precursors of melanoma remains controversial, as the exact risk of malignant transformation of many of these lesions is still unclear.

Bowen's Disease↗

PubMed2002

Common skin disorders of the penis.

Diseases of the male genitalia range from infectious lesions to inflammatory and neoplastic conditions, including many genital manifestations of more general skin diseases. This review highlights the clinical features, diagnosis and treatment of the most common dermatoses of the male genitalia. Herpes genitalis and infections caused by human papillomavirus (HPV) are increasing, particularly in young sexually active people. Herpes simplex virus infection is the commonest infectious cause of genital ulceration, with evidence that many infections are asymptomatic. HPV infection may be latent, subclinical and clinical. The most common causal agents for condyloma acuminatum are low-risk HPV 6 and 11; high-risk HPV types 16 and 18 are associated with premalignant and malignant lesions. Treatment for genital warts remains unsatisfactory; recurrences are common. Imiquimod, a new topical immunotherapeutic agent, which induces interferon and other cytokines, has the potential to be a first-line therapy for genital warts. Scabies and pediculosis are transmitted by skin-to-skin contact and sexual transmission is common, with the penis and scrotum favourite locations for scabious lesions. Oral ivermectin, a highly active antiparasitic drug, is likely to be the treatment of choice, but until approval is granted it should be reserved for special forms of scabies. Common skin diseases, e.g. psoriasis and lichen planus, may have an atypical appearance in the genital area. The typical psoriatic scale is usually not apparent because of moisture and maceration. Allergic contact dermatitis of the genital area may result from condoms, lubricants, feminine hygiene deodorant spray and spermicides. More often, contact dermatitis is irritant, resulting from persistent moisture and maceration. Lichen sclerosus is a chronic inflammatory disease that occurs as atrophic white patches on the glans penis and foreskin. The penile form is a common cause of phimosis in uncircumcised men; involvement of the urethral meatus may lead to progressive meatal stenosis. Plasma cell balanitis is a benign, idiopathic condition presenting as a solitary, smooth, shiny, red-orange plaque of the glans and prepuce of a middle-aged to older man. Squamous cell carcinoma (SCC) in situ, e.g. erythroplasia of Queyrat and Bowen's disease, cannot be excluded clinically; their apparent clinical benignity may lead to lengthy periods of misdiagnosis and biopsy is required to confirm the diagnosis. SCC is the most common malignancy of the penis and the role of oncogenic HPV-types has been also established in SCC of the penis. Prevention of SCC of the penis presupposes an identification of risk factors, early detection of all pre-cancerous lesions and treatment of phimosis.

Balanitis↗

PubMed2001

Laser therapy for carcinoma in situ of the penis.

PURPOSE: Carcinoma in situ of the penis, also referred to as Bowen's disease or erythroplasia of Queyrat, may lead to invasive squamous cell carcinoma. We assessed the results of laser therapy for carcinoma in situ of the penis. MATERIALS AND METHODS: From 1986 to 2000 we treated 19 patients with carcinoma in situ of the penis with the neodymium:YAG or carbon dioxide laser. Treatment was assessed retrospectively. No patient was lost to followup. RESULTS: No complications developed and cosmesis was excellent. After 2 to 4 months 3 patients (16%) received repeat treatment because of incomplete disappearance of the lesion. Mean followup was 32 months. True carcinoma in situ recurrent in 5 patients (26%) at an average followup of 25 months (range 6 to 75), while 1 had infiltrating carcinoma. All patients with carcinoma in situ underwent repeat laser treatment. CONCLUSIONS: In our experience laser therapy is appropriate initial treatment for carcinoma in situ of the penis with excellent cosmetic and functional results. This therapy is also suited for recurrence without the need for more mutilating therapy. However, the high incidence of recurrence indicates the need for careful followup and patient self-examination.

Adult↗

PubMed2004

Recurrent verruciform xanthoma of the vulva.

Verruciform xanthoma is a rare, benign, mucocutaneous, nondestructive lesion characterized by proliferation of non-Langerhans lipid-rich histiocytes. We describe the clinical and pathologic findings in a 30-year-old female with recurrent verruciform xanthoma of the vulva 8 years after initial therapy. The differential diagnosis includes seborrheic keratosis, verruca simplex, condyloma acuminatum, granular cell myoblastoma, vulvar intraepithelial neoplasia, bowenoid papulosis, erythroplasia of Queyrat, and verrucous carcinoma.

Adult↗

PubMedDate not supplied

Erosive lichen planus involving the glans penis alone.

A 71-year-old white man was first seen in September 1978. He complained of an asymptomatic recurrent red patch, which had been slowly enlarging for two months on the glans penis. The patient stated he had a similar lesion a year before, which disappeared completely after one month of treatment with a topical corticosteroid. Physical examination revealed a single, glistening, erythematous, round patch, 1.5 cm in diameter, on the dorsal surface of the glans penis. The central area seemed somewhat depressed with minute erosions scattered over the lesion (Fig. 1). The inguinal nodes were not enlarged and nothing was found on the skin or other mucous membranes. The diagnoses entertained at that time were plasma cell balanitis, erythroplasia of Queyrat, fixed drug eruption, lichen planus, erosive balanitis and solitary plasmocytoma. Laboratory studies were normal. A biopsy of the lesion showed: ulcerated or atrophic epidermis; hypergranulosis; hydropic degeneration of the basal layer; many Civatte bodies within the lower epidermis and the upper zone of papillary dermis; occasional clefts between the epidermis and the dermis; a band-like infiltrate in the papillary dermis, which composed almost entirely of plasma cells, seemed to impinge on the epidermis (Fig. 2). The lesion was diagnosed as lichen planus, erosive type. The patch disappeared in about 4 weeks with topical steroids. No relapse has occurred after a year.

Aged↗

PubMed1986

Plasma cell balinitis of Zoon.

Superficial lesions of the glans penis can pose diagnostic difficulties. Plasma cell balanitis is such a condition and it may be confused clinically with erythroplasia of Queyrat. It is unresponsive to topical medication and curable only by circumcision.

Aged↗

PubMed2006

Total glans resurfacing for premalignant lesions of the penis: initial outcome data.

OBJECTIVE: To report our initial experience of total glans resurfacing (TGR), as premalignant lesions of the glans penis have conventionally been treated by local excision, topical chemotherapy, laser or cryotherapy, but these techniques are frequently associated with high local failure rates and unsightly scarring that can make monitoring by gross inspection difficult. PATIENTS AND METHODS: TGR involves removing the glans and subcoronal epithelial and subepithelial tissues down to the corpus spongiosum of the glans and Buck's fascia at the coronal sulcus. The denuded glans penis is then covered with an extra-genital skin graft. Ten patients underwent TGR: six had recurrent erythroplasia of Queyrat after 5% 5-fluorouracil (5-FU) therapy; one had no clinical response to 5-FU or imiquimod; one had a severe allergic reaction and therefore could not tolerate 5-FU; and two had extensive glans hyperkeratosis and severe dysplasia. RESULTS: There were no postoperative complications. All skin grafts took successfully, and the cosmetic results were excellent. In all cases, pathological resection margins were clear. To date, there has been no evidence of disease recurrence on follow-up (median 30 months, range 7-45). CONCLUSIONS: TGR is a successful surgical alternative for managing intractable premalignant penile lesions. It has the potential to restore normal anatomy and minimize the risk of local recurrence by replacing diseased epithelium and subepithelial tissues with healthy extra-genital skin.

Adult↗