II. Epidemiology

  1. Occurs in uncircumsized men over age 60 years

III. Causes

  1. Genital Warts due to HPV infection (key causative factor)
  2. Local Trauma from heat, friction or inflammation

IV. Symptoms

  1. Asymptomatic in 50% of men (other than the lesions being present)
  2. Pain
  3. Pruritus

V. Signs

  1. Velvet-like Plaques on glans penis (Erythroplasia of Queyrat)
    1. Raised, beefy red irregularly shaped Plaques
      1. May be crusted, non-red lesions in uncircumsized patients
    2. Ulceration may occur
    3. Range in size from 0.2 cm up to 3.5 cm
    4. Distributed on the glans penis, Urethral meatus, coronal sulcus and foreskin
  2. Keratotic Plaques (Bowen Disease)
    1. Occur on penile shaft, scrotal skin, perineum

VI. Labs: Biopsy

  1. Biopsy all suspicious lesions

VII. Management

  1. Surgery
    1. Mohs Micrographic Surgery
    2. Circumcision if the lesion is isolated to the foreskin
  2. Topical agents have been used with varying success (5-FU, curettage, laser ablation, Aldara)
    1. Most topical treatments are associated with recurrence
  3. Radiation Therapy
    1. Consider in non-surgical candidates

VIII. Differential Diagnosis

IX. Complications

  1. Progresses to invasive Penile Squamous Cell Carcinoma in 5-30% of patients

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