Penile Carcinoma in Situ

1. Epidemiology
   1. Occurs in uncircumsized men over age 60 years
2. Causes
   1. Genital Warts due to HPV infection (key causative factor)
   2. Local trauma from heat, friction or inflammation
3. Symptoms
   1. Asymptomatic in 50% of men (other than the lesions being present)
   2. Pain
   3. Pruritus
4. Signs
   1. Velvet-like Plaques (erythroplasia of Queyrat)
      1. Raised, beefy red irregularly shaped Plaques
      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)
5. Labs: Biopsy
   1. Biopsy all suspicious lesions
6. Management
   1. Mohs Micrographic Surgery
   2. Circumcision if the lesion is isolated to the foreskin
   3. Other topical agents have been used with varying success (5-FU, curettage, laser ablation, Aldara)
      1. Most topical treatments are associated with recurrence
7. Differential Diagnosis
   1. Psoriasis
   2. Zoon Balanitis
8. Course
   1. Progresses to invasive penile Squamous Cell Carcinoma in 5-30% of patients
9. References
   1. Gerber (1994) J Urol 151(4): 829-33
   2. Teichman (2010) Am Fam Physician 81(2): 167-74