Penile intraepithelial neoplasia: clinical spectrum and treatment of 35 cases

Abstract

We recommend vigorous treatment of all patients with PIN, including circumcision. Smoking should be actively discouraged. Patients should have life-long follow-up and partners of patients with BP should be screened for other forms of intraepithelial neoplasia (cervical and anal).

BritishAssociation ofDermatologists' guidelines for the management of squamous cell carcinomain situ(Bowen's disease) 2014

“…EQ presents as one or more red, moist plaques on the mucosal surfaces of the glans and inner aspect of the foreskin, while BDP should be used to describe red, sometimes slightly pigmented, scaly patches and plaques of the keratinized penis. 147 EQ seems to have a higher propensity than BDP to undergo malignant transformation into SCC. 149 In contrast to EQ, the lesions of BP occur in a younger age group, occurring in young, sexually active men.…”

“…Circumcision removes a major risk factor for cancer and provides more extensive tissue for histology. 149 5-FU as a 5% cream is a well-established conventional option for the treatment of BDP, EQ and BP, 147,149,157 but there have not been any clinical trials. Treatment options for EQ include the use of topical 5-FU, imiquimod or PDT, although much of the evidence of efficacy depends on case reports.…”

“…147,148 Although EQ and BDP are sometimes used interchangeably, they are clinically distinct. EQ presents as one or more red, moist plaques on the mucosal surfaces of the glans and inner aspect of the foreskin, while BDP should be used to describe red, sometimes slightly pigmented, scaly patches and plaques of the keratinized penis.…”

“…Lack of circumcision, HPV, 150 infection and genital lichen sclerosus [151][152][153][154] are important risk factors in all forms of PIN. 147,155 Circumcision is therefore an essential component of the management of most cases of PIN. 147 PIN that is associated with HPV tends to be more undifferentiated, and histologically associated with full-thickness dysplasia (bowenoid), while PIN associated with lichen sclerosus is differentiated, and can therefore be more subtle histologically and easily overlooked on histopathology.…”

“…147,155 Circumcision is therefore an essential component of the management of most cases of PIN. 147 PIN that is associated with HPV tends to be more undifferentiated, and histologically associated with full-thickness dysplasia (bowenoid), while PIN associated with lichen sclerosus is differentiated, and can therefore be more subtle histologically and easily overlooked on histopathology. 155 There are increasing reports of PIN in association with biologics for the treatment of rheumatology and dermatology patients.…”