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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].

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]
  • BJU Int 98(3):532–536 CrossRef PubMed 10. von Krogh G, Horenblas S (2000) The management and prevention of premalignant penile lesions. Scand J Urol Nephrol Suppl 205:220–229 11.[springermedizin.de]
  • 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]

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

  • 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]
  • Among the patients treated with the CO2 laser, 81.4 % of cases had complete remission after one session of treatment.[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]
  • Imiquimod 5% is a suitable treatment for patients with EQ, and the treatment response can be evaluated using OCT.[ncbi.nlm.nih.gov]
  • Only few reports exist on the use of topical PDT in the treatment of EQ. We report 11 cases of EQ treated by topical methylaminolaevulinic acid (MAL) PDT.[ncbi.nlm.nih.gov]

Prognosis

  • Of the methods reviewed, the CO2 laser offered the most promising results with a cosmetically excellent prognosis.[ncbi.nlm.nih.gov]
  • 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[medlineplus.gov]
  • Prognosis and Clinical Course Lesions of EQ persist and enlarge slowly, and they typically have been present for several years (an average of 3.4 years in one study) before a biopsy is taken.[dermaamin.com]

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]
  • ERYTHROPLASIA OF QUEYRAT Etiology and Pathogenesis Erythroplasia of Queyrat (EQ) is an in situ SCC affecting the mucosal surfaces of the penis in uncircumcised males. This condition was described by Queyrat in 1911 as “erythroplasie du gland.”[dermaamin.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]
  • 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]

Epidemiology

  • It had been believed that carcinoma of the penis was rather rare in the developed countries comparing with that in the under-developing countries, however, the recent epidemiological studies failed to reveal any clear difference of the incidence of carcinoma[pubfacts.com]
  • […] 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.medscape.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]
  • 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]
Sex distribution
Age distribution

Pathophysiology

  • 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

  • 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]
  • 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]
  • […] 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]
  • Primary Prevention There are no established primary preventive measures for preventing penile carcinoma in situ.[wikidoc.org]
  • BJU Int 98(3):532–536 CrossRef PubMed 10. von Krogh G, Horenblas S (2000) The management and prevention of premalignant penile lesions. Scand J Urol Nephrol Suppl 205:220–229 11.[springermedizin.de]

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