Initially described more than 100 years ago, Erythroplasia of Queyrat (EQ) is a distinct clinical entity denoting a pre-cancerous lesion of the squamous cell carcinoma (SCC) in situ of the penis [1] [2]. It is rarely encountered in clinical practice and appears on the penile mucosal surfaces - the glans, coronal sulcus and prepuce, while the urethral meatus is also reported as a potential site [2] [3]. Many studies have classified Bowen's disease (BD) and EQ as the same entity because of their striking similarity on histological examinations, but the different location of BD (mainly seen on the skin of the penile shaft) differentiates the two terms in the majority of literature [2] [3]. Elderly patients are the principal population in whom EQ is diagnosed, and the presence of a phimotic foreskin, as well as an uncircumcised penis, are considered to be risk factors, as they are encountered in the vast majority of patients [1] [3]. The typical presentation involves a well-demarcated, shiny, bright-red, or red velvet-colored patches or plaques (either solitary or multiple) that are painless, although erosions may be noted [1] [2] [3]. However, because these lesions resemble numerous dermatologic conditions (including psoriasis, dermatitis, any of the sexually transmitted infections that present in a similar fashion, lichen planus, Zoon's balanitis, etc), the diagnosis might be initially missed [1] [2] [3] [4] [5].

• Ulcer

  Inorganic arsenic ingestion, radiation dermatitis (x-ray damage), immunosuppression or HIV, burn scars, and chronic ulcers are also associated with BD. [mitchmedical.us]

  Clinically, the presence of ulceration and/or papillary lesions usually corresponds to progression into an invasive carcinoma. [wikidoc.org]

   It may ulcerate and may be associated with discharge and pain  Bowen’s disease is characterized by sharply defined plaques of scaly erythema on the penile shaft. [slideshare.net]

  The bright red lesions may be ulcerated. The disease progresses slowly, and the interval between onset and diagnosis may be years. The cause is unknown. Diagnosis is confirmed only by histologic examination. [ncbi.nlm.nih.gov]

• Skin Patch

  The different techniques used are external beam radiotherapy, Grenz rays, and radioactive skin patches. The procedure is expensive and requires referral to a facility that has the ability to perform it. [dermatologyadvisor.com]

• Mental Distress

  The removal of cancer by partial or total penectomy is a standard therapy, but these radical procedures can cause considerable mental distress, including suicide. [scielo.br]

• Penile Lesion

  We have investigated 12 paraffin-embedded biopsies from eight patients with penile erythroplasia of Queyrat and control biopsies of inflammatory penile lesions, of genital Bowen's disease, and of premalignant/malignant cervical or vulvar lesions by 10 [ncbi.nlm.nih.gov]

  A therapeutic regimen of 5 per cent 5-fluorouracil cream applied to lesion(s) twice daily for four to five weeks has produced a high cure rate and maintained penile integrity and function. [goldjournal.net]

• Genital Lesions

  Skin: Structure and Functions lesion. The lesion can occur in other areas as well. The genital region, particularly the penile shaft, is also affected. [lecturio.com]

  The overall risk of progression of BD to invasive cancer is about 3% to 5%, However, risk is greater for patients with oral and genital lesions (about 10%), as well as those with a history of arsenic exposure or lesions located in a chronic scar or ulcer [mitchmedical.us]

  Genital lesions in males: Various forms of balanitis, erysipelas, lues stage II, psoriasis and erythroplasia Queyrat are possible differential diagnoses. [glosbe.com]

  CARBON DIOXIDE LASER TREATMENT OF EXTERNAL GENITAL LESIONS SAMUEL K. [cirp.org]

  Urology 16(2):181–182 Article CAS PubMed Google Scholar Rosemberg SK (1985) Carbon dioxide laser treatment of external genital lesions. [link.springer.com]

The importance of recognizing EQ early on lies in the fact that penile in situ squamous cell carcinoma (SCC) can arise from up to a third of patients who develop this lesion and approximately 20% of SCCs develop distant metastases [1] [2] [3] [5]. Furthermore, 5-year survival rates of invasive SCC range from 66%-27%, depending on the stage [6]. For these reasons, a meticulous physical examination of the penis and the genitalia is perhaps essential in recognizing EQ. As the presentation is nonspecific, the initial distinction between Bowen's disease (which is less likely to progress into SCC) and EQ should be made based on the location of the lesion, but a biopsy and subsequent histopathological examination is necessary to rule out other etiologies and confirm EQ as the presenting lesion [4] [5]. Generalized hyperplasia (acanthosis), the presence of parakeratotic cells with hyperchromatic nuclei, focal erosions, dyskeratosis, and dermal infiltration of inflammatory cells are some of the most prominent histopathological findings described in the literature [4] [5].

Therefore, the development of a non-invasive alternative treatment for EQ is essential. We report the case of an EQ patient with penectomy indicated by an urologist, but who responded well to topical treatment with topical 5-fluorouracil. [ncbi.nlm.nih.gov]

Review of erythroplasia of Queyrat and its treatment. Urology. 1976;8:311-5. [scielo.br]

If topical regimens are chosen, failure for resolution after treatment course or clinical progression during treatment should be classified as treatment failure and new treatment options should be performed. [dermatologyadvisor.com]

Surgery is the standard treatment for erythroplasia of Queyrat. However, it can cause problems to the appearance and function of the penis. Photodynamic therapy is a non-surgical treatment modality. [ijdvl.com]

Circumcision is the most recommended treatment. - How much would the treatment for EQ cost? The expenditure for the treatment will vary depending upon the type of treatment chosen. [theestheticclinic.com]

The prognosis for cure is excellent in most cases. [mountsinai.org]

Of the methods reviewed, the CO 2 laser offered the most promising results with a cosmetically excellent prognosis. [miami.pure.elsevier.com]

treatment, prevention, prognosis, and additional useful information HERE. [dovemed.com]

[…] such as: Mohs micrographic surgery or other surgical procedures to remove the area Laser surgery Freezing the cancer cells ( cryotherapy ) Scraping away cancer cells and using electricity to kill any that remain (curettage and electrodesiccation) The prognosis [nlm.nih.gov]

[…] nonspecific, the initial distinction between Bowen's disease (which is less likely to progress into SCC) and EQ should be made based on the location of the lesion, but a biopsy and subsequent histopathological examination is necessary to rule out other etiologies [symptoma.com]

Lentigo maligna (LM) Definition : precancerous lesion with intraepithelial proliferation of dysplastic melanocytes Epidemiology : : peak incidence : 70–90 years Etiology : : exposure to UV light Lesion Mostly found in areas exposed to sun (e.g., face, [amboss.com]

The etiology remains unclear. However, following may be some of the predisposing factors for development of Bowen Disease of the Glans Penis: Lack of circumcision Immunosuppression (eg. [theestheticclinic.com]

Diagnosis In doubt of the etiology or resistance to standard care, a microbiological culture and/or biopsy should be obtained. [urology-textbook.com]

Etiology Pathophysiology Bowen’s disease may evolve de novo or from a preexisting actinic keratosis. [dermatologyadvisor.com]

"Penile cancer: epidemiology, pathogenesis and prevention". World Journal of Urology. 27 (2): 141–150. doi:10.1007/s00345-008-0302-z. ISSN 0724-4983. ↑ Douglawi, Antoin; Masterson, Timothy A. (2017). [wikidoc.org]

Lentigo maligna (LM) Definition : precancerous lesion with intraepithelial proliferation of dysplastic melanocytes Epidemiology : : peak incidence : 70–90 years Etiology : : exposure to UV light Lesion Mostly found in areas exposed to sun (e.g., face, [amboss.com]

However, the epidemiology and anatomical location of these two conditions are mutually exclusive.5 Similar to Bowen's disease (BD), the presence of infiltration, nodularity, and/or ulceration often suggests a possible conversion to an invasive squamous [ncbi.nlm.nih.gov]

However, the epidemiology and anatomical location of these two conditions are mutually exclusive.55 Dahlgren S, Nordenstrom B. Transthoracic needle biopsy. [scielo.br]

Bleeker MCG, Heideman DAM, Snijders PJF, et al: Penile cancer: epidemiology, pathogenesis, and prevention. World J Urol 2009; 27: pp. 141-150. Harrington KJ, Price PM, Fry L, Witherow RO. Erythroplasia of Queyrat treated with isotretinoin. Lancet. [bradyurology.blogspot.com]

Etiology Pathophysiology Bowen’s disease may evolve de novo or from a preexisting actinic keratosis. [dermatologyadvisor.com]

Bowen Classification There is no established classification for Balanitis caused by Penile carcinoma in situ Pathophysiology Pathophysiology of penile carcinoma in situ include: [1] [2] [3] [4] [5] [6] [2] [7] Bowenoid papulosis The exact pathogenesis [wikidoc.org]

Prevention There are no established measures for the prevention of erythroplasia of Queyrat. References ↑ Weidner, Noel (2009). Modern surgical pathology. Philadelphia, PA: Saunders/Elsevier. [wikidoc.org]

Treatment and Prevention Prevention of EQ in uncircumcised males may be maximized by adherence to good personal hygiene regimens, and early circumcision may also reduce the incidence of this disease. [dermaamin.com]

[…] upon early diagnosis and treatment that is administered Please find comprehensive information on Squamous Cell Carcinoma In Situ of Penis regarding definition, distribution, risk factors, causes, signs & symptoms, diagnosis, complications, treatment, prevention [dovemed.com]

Management strategy The goals of treatment in both Bowen’s disease and EQ are cure and prevention of progression to invasive squamous cell carcinoma, while maintaining function and cosmesis. [clinicalgate.com]

1. Fanning DM, Flood H. Erythroplasia of Queyrat. Clin Pract. 2012;2(3):e63.
2. Choi JW, Choi M, Cho KH. A Case of Erythroplasia of Queyrat Treated with Imiquimod 5% Cream and Excision. Ann Dermatol. 2009;21(4):419-422.
3. Shabbir M, Minhas S, Muneer A. Diagnosis and management of premalignant penile lesions. Ther Adv Urol. 2011;3(3):151-158.
4. Öztürk S, Uçak H. Queyrat erythroplasia accompanied by bladder cancer in a circumcised male. Indian J Med Res. 2014;139(4):650-651.
5. Divakaruni AK, Rao AV, Mahabir B. Erythroplasia of Queyrat with Zoon's balanitis: a diagnostic dilemma. Int J STD AIDS. 2008;19(12):861-863.
6. Aster JC, Abbas AK, Robbins SL, Kumar V. Robbins basic pathology. Ninth edition. Philadelphia, PA: Elsevier Saunders; 2013.