Verrucous carcinoma arising in pseudoepitheliomatous keratotic and micaceous balanitis, without evidence of human papillomavirus

Abstract

Pseudoepitheliomatous keratotic and micaceous balanitis (PKMB) is a condition which occurs on the glans penis of older men and may be associated with the development of a verrucous carcinoma. A role for human papillomavirus (HPV) in the aetiology of verrucous carcinoma has been implicated and several different HPV types have been found. We report a 74-year-old man who developed a verrucous carcinoma within an area of PKMB on the glans penis. Using a broad-spectrum polymerase chain reaction technique for identifying HPV, the epidermis of the area of PKMB and of the verrucous carcinoma were examined and no HPV DNA was identifiable. These results suggest that there is no part for HPV in the pathogenesis of PKMB or its transformation to verrucous carcinoma.

Penile cancer

“…212,215,216 It has an indolent, chronic, relapsing course. Local invasion with malignant transformation toward either SCC or verrucous carcinoma has been reported, 183,213,215,[217][218][219][220] with malignant transformation clinically appearing as a nodule arising within the plaque (Fig 2).…”

“…177,179,180 Since HPV 6 and 11 are low-risk HPV types often detected in benign lesions, it has been hypothesized that the synergistic effect of other cofactors is probably involved in the pathogenesis of this disorder. These include environmental conditions (poor hygiene, lack of circumcision, and chronic irritation), 174 immunosuppression, 181 and coexistence of other viral or inflammatory penile diseases (lichen sclerosus 172,182 ; pseudoepitheliomatous, keratotic, and micaceous balanitis 183 ; and lichen planus 184 ). Enhancement of the oncogenic properties of these low-risk viruses by genomic alterations has also been suggested on the basis of several observations (rearrangements of the noncoding region in DNA sequences, subtle aminoacid changes in the HPV 6 E7 protein, etc.).…”

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

“…Verrucous carcinomas are not strictly associated with HPV. An example of a HPV-negative verrucous carcinoma is that arising in pseudoepitheliomatous keratotic and micaceous balanitis [13]. HPV-related anogenital squamous cell carcinoma has been reported to occur more frequently in HIV-seropositive patients.…”

Pseudoepitheliomatous keratotic and micaceous balanitis with malignant transformation

“…[8] Whenever, there is cellular atypia, local surgical excision produces excellent cosmetic and functional results. [9] When frank malignancy is seen excision with wide margin is the rule. [8]…”