Necrobiotic granulomas localised to the penis: a possible variant of subcutaneous granuloma annulare

Abstract

Three young men developed multiple firm asymptomatic nodules confined to the shaft of the penis. Skin biopsies from all 3 cases showed prominent necrobiotic granulomas indistinguishable from granuloma annulare. One of the patients had repeated recurrent nodules confined to the penis which were removed surgically over a period of 20 months. This unusual, but benign, presentation of granuloma annulare has to be distinguished from other granulomatous and malignant processes which may present as penile nodules.

Subcutaneous granuloma annulare of the penis in 2 adolescents

“…Development of further nodules within the months after excision may occur [5,8], as was the case in the second patient described. Deep GA in other sites in children appears to have a high rate of recurrent lesions postsurgical excision; this was reported in 79% of cases with at least a 6-month follow-up in a study of 19 children treated with surgical excision [1].…”

“…It generally overlies bony prominences, especially the anterior tibia, foot, occipital scalp, and hands [1][2][3]. Granuloma annulare of the penis is very rare, with only 7 cases reported to date [4][5][6][7][8] and no previous reports in children or adolescents to our knowledge. All except one [6] of the cases was of the nodular form.…”

“…It is not clear whether the previous reported cases of subcutaneous GA of the penis described were uncircumcised. The third case was described by Kossard et al [8], a 26-year-old man in whom circumcision was performed at the time of removal of the GA nodules and in whom there was no recurrence 2 years after surgery.…”

Necrobiosis Lipoidica of the Glans Penis

“…A number of cases of GA located only on the penis have been reported (8)(9)(10)(11). All of these cases bore marked clinical differences from the patients who had NL of the glans penis.…”

“…The key clinical feature was the presence of firm, asymptomatic nodules on the shaft of the penis that did not ulcerate and did not leave scars. In some cases, spontaneous remission and remission after skin biopsy was reported (8)(9)(10)(11).…”