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].

• Localized Pain

  The patient had an erythematous and eroded lesion affecting more than 50% of the glans associated with bleeding and local pain. Despite previous indication of penectomy, he was successfully treated with topical 5-fluorouracil. [ncbi.nlm.nih.gov]

  Affected males complain of localized pain, pruritus, difficulty retracting the foreskin over the glans, bleeding, and crusting. Histopathology Histopathologically, EQ is similar to BD as previously described. [dermaamin.com]

• Ulcer

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

  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]

  Early lesions present as an ulcer, nodule or warty growth on the glans or inner surface of the prepuce. More advanced tumors are usually large, ulcerated and fungating. The presence of a prepuce may obscure the tumor until it is well advanced. [med-ed.virginia.edu]

  Figure 1 Figure 1: Growth involving glans as well as prepuce Figure 2 Figure 2: Partial penectomy Case 2 A 54-year-old male presented with a non-healing ulcer over the glans (fig. 3). He also complained of foul-smelling discharge from the ulcer. [ispub.com]

  The carcinoma may be present as a well-defined red patch; is frequently solitary, but may be many in number The lesion may itch, ulcerate, or even bleed. [dovemed.com]

• Suggestibility

  Because the results of tests for human papillomavirus infection were negative in this case, we suggest that imiquimod may have acted through an antitumor effect mediated by cytokine activation. [ncbi.nlm.nih.gov]

• Anger

  CrossRef PubMed Google Scholar Angerer-Shpilenya M, Gaisa NT, Jakse G. Excision of carcinoma in situ of the glans penis with reconstructive plastic surgery. Urologe A. 2010;49(3):392–5. [link.springer.com]

• Excitement

  Photodynamic therapy (PDT) employs a photosensitizer excited by visible light. The resulting photodynamic reaction selectively destroys atypical cells. Only few reports exist on the use of topical PDT in the treatment of EQ. [ncbi.nlm.nih.gov]

• 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]

  Objective : To determine the incidence of penile intraepithelial neoplasia in the Netherlands using a nationwide histopathology registry and to discuss the nomenclature of premalignant penile lesions. [pubfacts.com]

• Genital Lesions

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

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

  Rosemberg SK (1985) Carbon dioxide laser treatment of external genital lesions. Urology 25(6):555–558 CrossRef PubMed 26. Greenbaum SS et al (1989) Carbon dioxide laser treatment of erythroplasia of Queyrat. [springermedizin.de]

  The genital lesion first appeared several years prior and was considered to be psoriasis. He had applied topical vitamin D cream and topical tacrolimus ointment on the lesion for two months, but there was no clinical improvement. [ncbi.nlm.nih.gov]

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].

The treatment is often difficult and associated with significant recurrence rates, especially in cases with urethral involvement. To evaluate carbon dioxide laser treatment in a case of erythroplasia of Queyrat with urethral involvement. [ncbi.nlm.nih.gov]

Carbon dioxide laser treatment of erythroplasia of Queyrat: a revisited treatment to this condition. J Eur Acad Dermatol Venereol. 2005 Sep. 19(5):643-4. [Medline]. Arlette JP. Treatment of Bowen's disease and erythroplasia of Queyrat. [emedicine.com]

Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 31. Updated by: David L. [nlm.nih.gov]

Among the patients treated with the CO 2 laser, 81.4 % of cases had complete remission after one session of treatment. [miami.pure.elsevier.com]

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]

If treated, however, the prognosis is excellent. [amboss.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]

[…] 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]

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

Leukoplakia: Etiology  No etiologic factor can be identified for most persistent oral leukoplakias (idiopathic leukoplakia). [slideshare.net]

Etiological factors include prolonged exposure to solar radiation, ingestion of chemical agent (arsenics) or human papillomavirus infection. Arsenic exposure: Major public health hazard - Pathology of Arsenic Poisoning. [histopathology-india.net]

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]

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]

Squamous cell carcinoma Epidemiology In countries with high circumcision rates the incidence of squamous cell carcinoma of the penis is very low and correspondingly more common in countries where the practice is not routine. [med-ed.virginia.edu]

[…] and is usually due to HPV 16 ( Int J Exp Pathol 2009;90:182 ) Bowen disease: clinical designation of carcinoma in situ located in the shaft Erythroplasia of Queyrat: clinical designation of carcinoma in situ located in the glans, usually erythematous Epidemiology [pathologyoutlines.com]

SCCIS) of the mucocutaneous epithelium of the penis. [1] Some references extend use of the term erythroplasia of Queyrat to also describe SCCIS of the labia minora, vestibule, vulva, labia majora, conjunctivae, buccal mucosa, and anal mucosa. [1, 3, 6] Epidemiology [emedicine.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]

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]

Primary Prevention There are no established primary preventive measures for preventing penile carcinoma in situ. [wikidoc.org]

[…] 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]

[…] in circumcised men, particularly if they are circumcised as newborns. [ 6 ] Other preventative measures include prevention of phimosis, treatment of chronic inflammatory conditions, smoking cessation, the use of condoms and prevention of HPV infection [patient.info]

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.