Pseudoepitheliomatous keratotic and micaceous balanitis treated with topical 5-fluorouracil and liquid nitrogen

Abstract

Pseudoepitheliomatous keratotic and micaceous balanitis (PKMB) is an uncommon premalignant condition involving the glans penis. We report the case of an 86-year-old man who presented with phimosis and pain on retracting his foreskin. He had previously undergone circumcision, which revealed a hyperkeratotic plaque with thin mica-like scales involving his glans penis. Histology of the lesion showed hyperkeratosis, parakeratosis, epidermal acanthosis and papillomatosis with no evidence of dysplasia. Immunohistochemistry for human papillomavirus was negative. The patient was treated with topical 5-fluorouracil and liquid nitrogen with clinical improvement. He is now under long-term surveillance for verrucous carcinoma and squamous cell carcinoma.

Pseudoepitheliomatous, keratotic, and micaceous balanitis mimicking lichen sclerosus et atrophicus

“…Pseudoepitheliomatous, keratotic, and micaceous balanitis in fact can resemble both clinically and histologically genital hypertrophic lichen sclerosus et atrophicus [7]; both have a risk of malignant transformation. Our patient previously received a diagnosis of lichen sclerosus et atrophicus, suggesting a link between the two conditions.…”

Pseudoepitheliomatous keratotic and micaceous balanitis: low-risk human papilloma virus detection in two further cases

“…6–8 Treatment is often variable, ranging from topical therapy with imiquimod, 5-fluoruracil, podophyllin, steroids to physical therapies such as cryotherapy or topical photodynamic therapy, electrocoagulation and/or CO 2 laser. 9,10 Advanced stages require wide margins surgery. 11…”

Pseudoepitheliomatous keratotic and micaceous balanitis: A literature review

“…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.…”

“…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.…”

“…6,12,14,20 Eight patients (33.3%) had a 'pushing' pattern, characteristic of verrucous carcinoma. 2,3,6,8,14,17,19 Five patients progressed to more advanced disease: carcinoma in situ or Bowen disease (n = 2), 12,16 well differentiated infiltrative squamous cell carcinoma (n = 2) and spindle cell fibrosarcoma (n = 1). 10,14,21 A total of 13 patients (54.1%) were prescribed 5-Fluorouracil (5-FU) once daily for at least one month; however, 7 (53.1%) of them were resistant to it.…”