Multiple giant angiokeratoma of Fordyce on the shaft of the penis masquerading as keratoacanthoma

Abstract

The term 'angiokeratoma' includes a wide range of dermatological conditions of hyperkeratotic vascular disorders with a similar histologic combination of hyperkeratosis and superficial dermal vascular ectasia. Angiokeratomas can be classified into localized and systemic forms. Angiokeratoma of Fordyce (AKF) is a localized form of angiokeratoma, clinically characterized by 1- to 6-mm, black, blue, or dark red, dome-shaped papules located on the scrotum, shaft of penis, labia majora, clitoris, inner thigh, and lower abdomen. We describe herein a case of giant angiokeratoma of Fordyce on shaft of the penis in an elderly man, clinically masquerading as keratoacanthoma.

Penile Angiokeratomas (PEAKERs) Revisited: A Comprehensive Review

“…Angiokeratomas were also present on the scrotum in 11 of the 54 men (20%) with PEAKERs [ 6 , 7 , 10 , 15 , 18 , 23 , 25 ], current report. This was more commonly observed in men with PEAKERs on their glans penis (seven men) [ 6 , 18 , 25 ], current report, than those with PEAKERs on their penile shaft (four men) [ 7 , 10 , 15 , 23 ].…”

“…Four men (10%), including one of our patients, had PEAKERs that were treated with electrocautery [10,14,23], current report. Radiofrequency was used to excise multiple giant PEAKERs on the penile shaft that mimicked keratoacanthomas in a 72-year-old man who also had several smaller angiokeratomas on his penis and scrotum that were treated with electrocautery [23].…”

“…The location of the PEAKERs were available for all of the 54 men. More than 90% of the angiokeratomas were on either the glans penis (55.5%, 30 men) [ 4 – 6 , 8 , 9 , 11 – 18 , 20 – 25 ], current report, or the penile shaft (35%, 19 men) [ 1 , 7 , 10 , 12 , 13 , 15 , 16 , 23 ]. Less commonly, the lesions were on either the foreskin (5.5%, three men) [ 1 ] or both the glans penis and the penile shaft (4%, two men) [ 13 ].…”

“…PEAKER-associated symptoms were observed in 39% (16 of 41) of men. These included bleeding (12 men) [5,7,8,16,23,25], current report, increasing size of the lesions (10 men) [5,7,11,16,17,25], abrupt onset of new lesions (2 men) [17,21], pain (2 men) [16], current report, and/or pruritus (2 men) [7], current report. Multiple symptoms were experienced by ten men: two symptoms (eight men) [5,7,25], current report, or three symptoms (two men) [7,16].…”

“…The giant angiokeratomas on the penile shaft of a 72-year-old man clinically masqueraded as keratoacanthomas by appearing as dome-shaped nodules with a keratinous plug in the central crateriform ulcer. In addition, the man had multiple smaller angiokeratomas presenting as keratotic papules on both the shaft of his penis and his scrotum [23].…”