It is not uncommon for family physicians, dermatologists, and urologists to encounter patients in their practices with penile cutaneous lesions. The differentiation of premalignant lesions from benign dermatosis can be a challenging task due to the rarity of some of these conditions, as well as the overall low incidence of penile neoplasms in industrialized nations.1 A retrospective British study found that one-fifth of patients with penile carcinoma are first referred to specialists other than urology.2 Thus, early investigation is fundamental for the treatment of these lesions, which may have already suffered significant diagnostic delays due to either lack of knowledge for these conditions or patient-related stress/embarrassment from genital malady.
The etiology for these cutaneous lesions can range from benign causes, which can be classified as infectious vs. noninfectious, to neoplastic conditions, along with associated risks of morbidity and psychosocial distress. Clinical presentation of these lesions can guide diagnosis and treatment in the majority of cases. A biopsy is indicated whenever diagnosis is in doubt. Irregular erythematous patches or keratotic plaques should have prompt evaluation due to the possibility of carcinoma in situ. Most benign lesions can be managed with observation or corticosteroids, while neoplastic lesions typically will require more extensive excision, along with a thorough workup.
This review aims to provide a practical approach to the various aspects of diagnosis and management of penile cutaneous lesions. It is not a complete list of diagnoses, but rather a compilation of some of the most encountered ailments in a community practice. In some cases, a multidisciplinary approach in formulating treatment recommendations for those with suspected or confirmed cancer is also recommended. It is hoped that this primer will provide clinicians with a basic understanding of the different diagnostic and therapeutic approaches in the management of penile lesions.
References
- 1.Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66:7–30. doi: 10.3322/caac.21332. [DOI] [PubMed] [Google Scholar]
- 2.Lucky MA, Rogers B, Parr NJ. Referrals into a dedicated British penile cancer centre and sources of possible delay. Sex Transm Infect. 2009;85:527–30. doi: 10.1136/sti.2009.036061. [DOI] [PubMed] [Google Scholar]