Review of cutaneous penile lesions

Abstract

Introduction: Penile lesions often go undiagnosed and are difficult to identify for general practitioners and specialists, yet the stakes could be high. Indeed, the condition is highly varied and includes physiological variants, specific skin entities, genital dermatoses, genital ulcers, balanitis, premalignant lesions, and, finally, cancerous lesions. Knowledge of these entities can help to prevent overlooking potentially progressive lesions and diagnose cancerous lesions early so that patients can be offered conservative treatment, improving chances of survival. We review here these different lesions. Materials and methods and authors personal experience: A literature review was carried out in December 2016 using the Medline/Pubmed database, without any restrictions regarding the time period but limiting the review to studies in English or French. The main keywords used were "penile lesion", "penile cancer", "balanitis" and "premalignant lesion". A specific review was performed for each type. All the pictures and cases came from our personal practice in our specific uro-dermatological consultation. All the patients gave us their informed consent for the utilization of their pictures. Results: We studied 66 references covering the field of benign and malignant lesions and their respective treatment. It is essential to take a medical history and perform a clinical examination, despite the fact that some lesions are not specific. A biopsy must be performed systematically in the case of all suspicious lesions. Conclusion: Lesions on genital organs in men are very diverse. Some are difficult to diagnose and treat, with the main challenge being early diagnosis of lesions with a high progressive potential in order to prevent dissemination and the need for mutilating surgery.

A solitary penile lesion

“…Inflammatory dermatoses such as psoriasis or lichen planus are also possible. 2,3 Neoplastic entities to be considered include Bowen's disease, bowenoid papulosis, erythroplasia of Queyrat and the less likely possibility of invasive squamous cell carcinoma. 3…”

Chronic balanitis: When should we be concerned?

“…5,6 Its aetiology is thought to be associated with inadequate bathing and/or contextual 'dysfunction' of the prepuce, causing either urine retention, smegma build-up, friction or heat, which ultimately results in chronic irritation of the mucosa. [5][6][7] It usually presents as shiny, moist, orange-red glazed, well-demarcated macule(s) with possible speckled orange-red plaques termed 'cayenne pepper spots'. 3,5 The diagnosis can be made clinically; however, a histopathological examination may be required to rule out malignancy and confirm Zoon's balanitis.…”

“…Zoon's balanitis can be persistent and relapse even after general and medical management. 7 Circumcision should be considered for patients with persistent symptoms who are non-adherent to general hygiene advice and/or refractory to medical management. 6 Resolution post-circumcision is expected to occur between six weeks and several months.…”