Lesions on the Penis

November 30, 2001

Case Report

A 30-year-old Caucasian man was referred by his dermatologist because of several asymptomatic lesions on the penis. He was healthy and never had surgery other than a circumcision as a neonate. He did not smoke, drink alcohol, use illicit drugs, or take any medication.

The lesions were primarily located on the distal shaft of the penis (Fig. 1a). The frenulum was minimally involved, but the coronal sulcus and meatus were not affected (Fig. 1b). The lesions were slightly raised, 1 to 3 mm wide, and curvilinear. The patient's physical examination was otherwise normal.

(A) Curvilinear raised papillary lesions appear along the distal shaft of the penis. (B) Lesion on the ventral aspect of the penis extends to the frenulum without involving the coronal sulcus.

(A) Curvilinear raised papillary lesions appear along the distal shaft of the penis. (B) Lesion on the ventral aspect of the penis extends to the frenulum without involving the coronal sulcus.

An incisional biopsy was performed. Microscopically (Figs. 2a, b, c), the biopsy of the penile lesion demonstrated a thinned hyperkeratotic epidermis characterized by atrophy of the stratum malpighii and loss of the rete ridges. The underlying upper dermis showed a homogeneous deposition of collagen and loss of elastic fibers. A band-like inflammatory response consisting mainly of lymphocytes and plasma cells was observed in the middermis.

(A) Low-power microscopy of the penile lesion shows thinning of the epidermis and atrophy of the stratum malpighii with loss of rete ridges. Underlying upper dermis has homogeneous deposition of collagen with loss of elastic fibers. An inflammatory reaction can be observed in the middermis. (B) High-power microscopy demonstrates hyperkeratosis of the epidermis. (C) High-power microscopy shows band-like inflammatory response consisting mainly of lymphocytes and plasma cells in the dermis.

(A) Low-power microscopy of the penile lesion shows thinning of the epidermis and atrophy of the stratum malpighii with loss of rete ridges. Underlying upper dermis has homogeneous deposition of collagen with loss of elastic fibers. An inflammatory reaction can be observed in the middermis. (B) High-power microscopy demonstrates hyperkeratosis of the epidermis. (C) High-power microscopy shows band-like inflammatory response consisting mainly of lymphocytes and plasma cells in the dermis.

(A) Low-power microscopy of the penile lesion shows thinning of the epidermis and atrophy of the stratum malpighii with loss of rete ridges. Underlying upper dermis has homogeneous deposition of collagen with loss of elastic fibers. An inflammatory reaction can be observed in the middermis. (B) High-power microscopy demonstrates hyperkeratosis of the epidermis. (C) High-power microscopy shows band-like inflammatory response consisting mainly of lymphocytes and plasma cells in the dermis.

What do you recommend as treatment?

  1. Partial penectomy

  2. Oral antibiotic therapy

  3. Topical or systemic antifungal therapy

  4. Steroid therapy and/or surgical excision

View the correct answer.

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