Efficacy of topical photodynamic therapy in the treatment of erythroplasia of Queyrat

Abstract

Erythroplasia of Queyrat (EQ) is an intraepidermal carcinoma in situ presenting clinically as a sharply demarcated, slightly raised erythematosus plaque on the glans penis or the inner side of the foreskin. Various treatment modalities for EQ have been proposed, including electrocautery and curettage, topical 5-floururacil cream, imiquimod cream, isotretinoin, cryotherapy, laser therapy, radiotherapy, ingenol mebutate gel and photodynamic therapy (PDT). Most of these treatments are limited by low clearance rates and frequent relapses. Surgical treatment including local excision, Mohs micrographic surgery and partial or total penectomy, ensures adequate healing rates. However, discomfort consequent to surgical treatment might be unacceptable. Topical PDT using the methyl ester of 5-aminolaevulinic acid (MAL) is an established non-surgical treatment of cutaneous precancerous lesions and skin cancers. We present the case of a 60-year-old uncircumcised man affected by EQ of the penis successfully treated with MAL-PDT, performed five times, two weeks apart, with no recurrences after 6 years.

Urologic dermatology: a comprehensive foray into the noninfectious etiologies of balanitis

“…Delgado et al 15 Pimecrolimus 1% ointment Malignancy risk Bari et al 17 Mupirocin 2% ointment Not well studied, mechanism unclear Retamar et al 20 CO2 Laser therapy Cost, lack of provider training Genital Lichen Planus ElAhmed et al 24 Oral antihistamines Drowsiness, anticholinergic Usatine et al 25 Topical corticosteroids -High potency Local epidermal and dermal changes (thinning, striae, atrophy) ElAhmed et al 24 Oral corticosteroids Immunosuppression Pavlotsky et al 26 UVB phototherapy No risk Lonsdale-Eccles et al 27 Tacrolimus 1% ointment Malignancy risk Balanitis Xerotica Obliterans Charlton et al 34 Topical corticosteroids -High potency Local epidermal and dermal changes (thinning, striae, atrophy) Charlton et al 34 Surgical intervention (i.e., circumcision, urethroplasty) 83 Topical imiquimod 5% cream Skin irritation, mild flu-like symptoms Jasterzbski & Schwartz 92 Excisional surgery Bleeding, infection, damage to surrounding structures, and death Erythroplasia of Queryat Antonio et al 89 Topical 5-fluorouracil 5% cream Skin irritation, allergic contact dermatitis, inflammatory colitis Lucky et al 83 Topical imiquimod 5% cream Skin irritation, mild flu-like symptoms Fanning et al 87 Local resection Bleeding, infection, damage to surrounding structures, and death Iafrate et al 88 Laser therapy…”

“…87 Bleeding, pain, ulceration, scaling, and crusting may also be present. 88 Biopsy is necessary to confirm diagnosis and assess potential invasion into the underlying dermis. Histologically, EoQ mimics squamous cell carcinoma in situ with full thickness atypia spanning across the epidermis.…”

“…Dermal invasion would indicate malignant transformation of the lesion. 88 Recently, dermoscopic features of EoQ have been well described. A study which used dermoscopy to distinguish EoQ from other forms of chronic balanitis found that glomerular vessels was the most predictive finding.…”

“…Treatment options include a combination of photodynamic and topical therapy with 5% imiquimod cream versus 5-FU, phototherapy, laser therapy, or local resection. 87,88,90 A pathological assessment for surgical margins is critical to decrease risk of recurrence. Total glansectomy with resurfacing has been shown to have the lowest rate of recurrence at 2% for treatment of small lesions.…”

“…11). 87 Bleeding, pain, ulceration, scaling, and crusting may also be present 88 . Biopsy is necessary to confirm diagnosis and assess potential invasion into the underlying dermis.…”