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Erythroplasia of Queyrat

Bowen Disease of the Glans Penis

Erythroplasia of Queyrat is a term used to describe a rare premalignant lesion of penile in situ squamous cell carcinoma. The glans is the predominant location of this lesion, and its non-specific presentation - a sharply defined red patch or plaque, may often lead to a misdiagnosis as one of many mucosal dermatoses. A biopsy with subsequent histopathological examination is necessary to confirm the diagnosis.


Presentation

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]
Italian
  • A retrospective analysis of real-life practice of off-label photodynamic therapy using methyl aminolevulinate (MAL-PDT) in 20 Italian dermatology departments. Part 2: oncologic and infectious indications.[emedicine.com]
Weakness
  • If you have Bowen’s disease, you’re at a higher risk for other types of skin cancers, especially if you have a weak immune system from disease or medical treatments. You should have regular follow-ups and skin checks with your doctor.[webmd.com]
Suggestibility
  • It is suggested that topical 5-FU is the treatment of choice for histologically confirmed EQ because of its superior results compared with thoseof surgery or radiation therapy.[ncbi.nlm.nih.gov]
  • Its cause is unknown but some evidence suggests infection with human papillomavirus in the pathogenesis of EQ; however, recent data do not confirm this. Therapy is difficult and associated with important recurrence rates.[ncbi.nlm.nih.gov]
  • 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]
  • The data suggest that in erythroplasia of Queyrat, in contrast to other genital neoplasias, a coinfection with human papillomavirus type 8 and carcinogenic genital human papillomavirus types occurs.[ncbi.nlm.nih.gov]
  • One prospective study suggests a superiority of ED&C over cryotherapy in treating BD, especially for lesions on the lower leg.[mitchmedical.us]
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
  • Human papillomavirus DNA was detected in all erythroplasia of Queyrat patients and in none of the controls with inflammatory penile lesions.[ncbi.nlm.nih.gov]
  • A middle-aged uncircumcised man presented with two long-standing erythematous prepucial penile lesions unresponsive to antibiotics.[ncbi.nlm.nih.gov]
  • Invasive tumours require staging of the primary penile lesion and inguinal and pelvic lymph nodes. Local staging can be performed using magnetic resonance imaging (MRI).[patient.info]
  • CONSUMERS: Click here for the Consumer Version Topic Resources Causes of Cutaneous Penile Lesions This lesion, another name for lichen sclerosus et atrophicus in men, is an indurated, blanched area near the tip of the glans surrounding and often constricting[merckmanuals.com]
Genital Lesions
  • 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]

Workup

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].

Treatment

  • Among the patients treated with the CO 2 laser, 81.4 % of cases had complete remission after one session of treatment.[ncbi.nlm.nih.gov]
  • Imiquimod 5% is a suitable treatment for patients with EQ, and the treatment response can be evaluated using OCT. 2013 S. Karger AG, Basel.[ncbi.nlm.nih.gov]
  • Two further patients with more extensive disease achieved a significant improvement, allowing easier treatment by laser vaporization.[ncbi.nlm.nih.gov]
  • The treatment is often difficult and associated with significant recurrence rates, especially in cases with urethral involvement. OBJECTIVE: To evaluate carbon dioxide laser treatment in a case of erythroplasia of Queyrat with urethral involvement.[ncbi.nlm.nih.gov]
  • Only few reports exist on the use of topical PDT in the treatment of EQ. OBJECTIVE: We report 11 cases of EQ treated by topical methylaminolaevulinic acid (MAL) PDT.[ncbi.nlm.nih.gov]

Prognosis

  • Of the methods reviewed, the CO 2 laser offered the most promising results with a cosmetically excellent prognosis.[ncbi.nlm.nih.gov]
  • […] 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]
  • Most therapies have an excellent response rate and the prognosis of Bowen disease in most cases is excellent. The response to a particular therapy may vary – what works for one person may be ineffective in another.[rarediseases.org]

Etiology

  • […] 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]
  • 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]

Epidemiology

  • 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]
  • 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]
  • […] 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]
  • Epidemiology [ 1 ] 95% of penile cancers are squamous cell carcinomas. [ 2 ] Other rare histological variants include malignant melanoma, basal cell carcinoma, extra-mammary Paget's disease and sarcoma. [ 3 ] In Western countries, primary malignant penile[patient.info]
  • Descriptive epidemiology of the cancers of male genital organs in greater Bombay. Indian J Cancer 1997;34:30. 3. Maden C, Sherman KJ, Beckmann AM, et al. History of circumcision, medical conditions, and sexual activity and risk of penile cancer.[ispub.com]
Sex distribution
Age distribution

Prevention

  • 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]
  • Primary skin cancer is the most common cancer afflicting mankind and is rising in inci dence, despite the fact that it is often preventable.[books.google.de]
  • […] 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]
  • The secondary development of phimosis inhibits washing and prevents early diagnostics of possible malignancy development on the glans or inside of the prepuce. A radical circumcision should therefore be performed for this disease.[oncolex.org]
  • To prevent malignant transformation, surgical excision is usually the treatment of choice.[amboss.com]

References

Article

  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.

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Last updated: 2018-06-21 22:39