Pseudoepitheliomatous keratotic and micaceous balanitis: A literature review

Abstract

Pseudoepitheliomatous keratotic and micaceous balanitis: A literature reviewPseudoepitheliomatous keratotic and micaceous balanitis (PKMB) is a rare, acquired penile disorder involving the glans penis. It was initially described in the French literature in 1966 by Lortat-Jacob and Civatte. 1 However, PKMB has not been well reported, and the nuances of its clinical presentation have not been described explicitly. An exploratory search in PubMed was conducted on 29 July 2020 using the following query: 'Pseudoepitheliomatous Keratotic and Micaceous Balanitis' or 'PKMB'. Abstracts identified during this search were screened, and articles pertaining to the topic were included in the final search study. Letters to the editors and articles not written in English were not included. The articles finally included (n = 23) were case reports published between 1977 and 2019, with a total of 24 patients. The mean age of the patients was 58.8 years (range, 35-86 years) (Table 1).The majority of patients had a slow growing, whitishyellow lesion on their glans penis with a scaly nail-like appearance. [2][3][4][5][6][7][8][9][10][11][12][13][14][15] Almost half (n = 13) of the patients (54.1%) were asymptomatic. In symptomatic patients, itching, irritation, erythema, pain, soreness, pruritus, urinary symptoms, sexual symptoms and telangiectasia were reported. 1,2,[11][12][13][14][16][17][18][19] Urinary and sexual symptoms occurred in 16.6% (n = 4) and in 8.3% (n = 2) of the patients, respectively. The duration of symptoms ranged from 2 months to 30 years, and 10 patients (41.6%) had a history of phimosis. [6][7][8][9]11,12,15,17,19,20 At the time of disease presentation, 19 patients (79.1%) were circumcised. Inguinal lymphadenopathy was not reported in the included patients.Histopathology of the lesion revealed hyperkeratosis and acanthosis in 14 patients.

Pseudoepitheliomatous keratotic and micaceous balanitis: a series of eight cases

“…One patient developed differentiated PeIN and three others had prior PeIN. Differentiated PeIN has not previously been described in association with PEKMB, although it is a known precursor of verrucous carcinoma that is strongly associated with PEKMB 3,5–8 . Verrucous carcinoma accounts for just 3–8% of all penile SCCs, 21 but 29.6% of SCCs in patients with a background of LSc 22 ; this furnishes further evidence for PEKMB as a manifestation of LSc.…”

“…Differentiated PeIN has not previously been described in association with PEKMB, although it is a known precursor of verrucous carcinoma that is strongly associated with PEKMB. 3,[5][6][7][8] Verrucous carcinoma accounts for just 3-8% of all penile SCCs, 21 but 29.6% of SCCs in patients with a background of LSc 22 ; this furnishes further evidence for PEKMB as a manifestation of LSc. The presence of basal atypia in threequarters of the patients biopsied, and the increased basal cellular proliferation in half of the biopsies stained, reflect the propensity to differentiated PeIN.…”

“…Our patients had a wide age range (32–75 years) with a third of our patients under the age of 50 years. Whilst this condition has typically been described in association with older males, 8 there are six case reports of men younger than 50.…”

Malignant Transformation of Long-Standing Pseudoepitheliomatous Keratotic and Micaceous Balanitis (PKMB) Presenting as Urethral Obstruction

“…The course of the disease is very slow and can remain stable for years, but in ominous cases, it can be complicated with verrucous or squamous cell carcinomas. Although once considered entirely benign and extremely rare, accumulating reports have shed light on its malignant propensity [ 3 , 4 ]. The clinical course of PKMB is chronic and associated with recurrences after treatment [ 5 ].…”