Is pseudoepitheliomatous, micaceous and keratotic balanitis synonymous with verrucous carcinoma?

Abstract

Two cases of pseudoepitheliomatous, micaceous and keratotic balanitis are presented and their clinical and histological features are discussed. This rare condition of the glans penis was originally thought to be benign, but more recent evidence indicates that the lesion is a manifestation of verrucous carcinoma. Consequently, the treatment of choice is excision with a wide margin. We suggest the new name, micaceous and verrucous malignant balanitis.

Pseudoepitheliomatous, Keratotic and Micaceous Balanitis

“…Our patient had a his tory of preexisting phimosis treated by circumcision in his late 30s as well as the original case [1] and 3 additional cases reported by Mann and Allen [9] and Beljaards et al [10]. Others however had an acquired phimosis, necessi tating circumcision [11].…”

“…The predisposing condition for and the cause of PEKMB are unknown [1,2,6,10]. Our patient had a his tory of preexisting phimosis treated by circumcision in his late 30s as well as the original case [1] and 3 additional cases reported by Mann and Allen [9] and Beljaards et al [10].…”

“…In third and fourth stage, partial penec tomy or more radical surgery according to the stage of the disease should be performed. The majority of PEKMB cases reported in English literature were unresponsive to topical treatment because their lesions were already in the second tumor stage [3,4, 10, 12,] or showed dysplasia and invasion [10,12]. Others [9], however, considered surgi cal treatment too radical for the initial phase of the treat ment, or had an excellent response with topical 5-FU, but the patient died a few weeks later of unrelated causes [6], Irvine's case [8] had effective treatment of PEKMB with cryosurgery, but subsequently developed fibrosarcoma of the penis.…”

“…This benign histology is retained in the tumor stage, although with a stepwise increase in benign hyperplasia reaching a climax in the large horny excres cence, a unique pathologic horn [4,6,11]. After a pro tracted course some of these horny lesions may show deep bulbous, squamous outgrowths, sinuses filled with kera tin, markedly increased basal cell activity indicated by increased cell density, variation in size and shape of the Pseudoepitheliomatous, Kcratotic and Micaceous Balanitis nuclei, and increased number of mitoses [3,10,12], This stage can be considered as third stage -transformation in the verrucous carcinoma. The latest, fourth stage will be invasion [10,12] -the appearance of squamous cell carci noma, where lymph node involvement or metastatic dis ease should also be investigated [2, 3, …”

Penile cancer

“…212,215,216 It has an indolent, chronic, relapsing course. Local invasion with malignant transformation toward either SCC or verrucous carcinoma has been reported, 183,213,215,[217][218][219][220] with malignant transformation clinically appearing as a nodule arising within the plaque (Fig 2).…”