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]

• Yawning

  By Richard Klasco, M.D Photo Credit Ask Well Photo Credit Why Do We Yawn? Reading about yawning makes people yawn. You are probably yawning right now. By Roni Caryn Rabin Latest Search Latest Articles Search Articles 13843 results for sorted by [nytimes.com]

• Ulcer

  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]

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

  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]

  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]

• 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

  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]

  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

  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]

  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]

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

  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].

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.