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Differential diagnoses of penile cancer

Benign changes can occur on the penis which are not easy to distinguish from malignant tumors. Some of these are considered premalignant.

  • Lichen sclerosis (Balanitis xerotica obliterans) is a skin condition localized to the glans and the prepuce which presents as white atrophic patches. The condition may lead to phimosis and meatal stenosis. The association between balanitis xerotica obliterans and penile cancer is slight, and the disease is most common in elderly men. The secondary development of phimosis inhibits washing and prevents early diagnostics of possible malignancy development on the glans or inside of the prepuce. A radical circumcision should therefore be performed for this disease.
  • Condyloma acuminata is a common sexually transmitted disease caused by a virus belonging to the human papilloma virus group. The lesions normally grow as a papilloma and are usually found on the glans, prepuce, or shaft of the penis. They are benign, caused by low-risk HPV 6/11, but mixed infections with high-risk HPV types are relatively common. Malignant transformation is not documented.
  • A variation of condyloma acuminata is giant condyloma acuminata. This disease is rare but shares the same histology as regular condylomas and grows very rapidly reaching grotesque sizes.These tumors may be similar to malignant tumors (verrucous carcinomas, papillary carcinomas and condylomatous carcinomas). These tumors do not metastasize, but may destroy the glans and prepuce, and become so large that a partial penis amputation is necessary. These patients usually seek medical help quickly because of the rapid tumor growth. Normal treatment is local extirpation without a mutilating effect.
  • Leukoplakias on the glans are rare. They appear as a white hypertrophic or atrophic patch and usually occur secondary to chronic irritation. The condition usually develops in the meatus. Biopsy is necessary to exclude cancer and intraepithelial neoplasia. (PeIN).
  • Bowen's, Erythroplasia de Queyrat and Paget's disease are  premalignant skin diseases that can occur on the shaft of the penis and scrotal skin, they must be biopsied and treated.
  • Bowen's disease is a clinical diagnosis which the pathologists now classify as undifferentiated PeIN. It manifests as a solitary, pigmented, scaly or scab-covered area that affects the penis shaft, scrotum, perineum, and the suprapubic area.
  • Erythroplasia de Queyrats is a clinical diagnosis which the pathologists now classify as undifferentiated PeIN, it grows on the glans and the prepuce where it presents as a well-defined, red patch.
  • Bowenoid papulosis is characterized by multiple, slightly elevated, red to violet or brownish papules, preferably on the penis shaft and scrotum. The condition, which is very rare, is preferably seen young men and going to regress without treatment. These are caused by high-risk HPV, most commonly HPV 16. Morphologically this cannot be separated from undifferentiated PeIN.

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