II. Epidemiology

  1. Occurs in uncircumsized men over age 60 years

III. Causes

  1. Genital Warts due to HPV infection (key causative factor)
  2. Local Trauma from heat, friction or inflammation

IV. Symptoms

  1. Asymptomatic in 50% of men (other than the lesions being present)
  2. Pain
  3. Pruritus

V. 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)

VI. Labs: Biopsy

  1. Biopsy all suspicious lesions

VII. 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

VIII. Differential Diagnosis

IX. Course

  1. Progresses to invasive penile Squamous Cell Carcinoma in 5-30% of patients

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