Erythroplasia of Queyrat (Bowen Disease of the Glans Penis) Clinical Presentation

  • Author: Kendall M Egan, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Oct 18, 2010
 

History

Patients with erythroplasia of Queyrat (Bowen disease of the glans penis) typically present with solitary or multiple nonhealing erythematous plaques on the glans penis and/or adjacent mucosal epithelium. The classic patient is a middle-aged to elderly uncircumcised man.

Presenting symptoms can vary and may include the following:

  • Redness
  • Crusting
  • Scaling
  • Ulceration
  • Bleeding
  • Pain
  • Itching
  • Dysuria
  • Penile discharge
  • Difficulty retracting the foreskin
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Physical

Solitary or multiple, minimally raised, erythematous papules and plaques on the glans penis and/or adjacent mucosal epithelium are seen in erythroplasia of Queyrat (Bowen disease of the glans penis). The plaques may be smooth, velvety, scaly, crusty, or verrucous. The classic lesion is described as a nontender, sharply demarcated, bright-red, glistening plaque on the glans penis of a middle-aged to elderly uncircumcised man. Ulceration or distinct papillomatous papules within a plaque may indicate progression to invasive squamous cell carcinoma. Note the image below.

Erythroplasia of Queyrat. Courtesy of Hon Pak, MD.Erythroplasia of Queyrat. Courtesy of Hon Pak, MD.
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Causes

Erythroplasia of Queyrat (Bowen disease of the glans penis) most often occurs in uncircumcised men. The precise etiology remains unclear. The following have been proposed to contribute to the development and progression of erythroplasia of Queyrat:

  • Lack of circumcision
  • Chronic irritation (urine, smegma, poor hygiene), inflammation, and chronic infections (herpes simplex virus, bacterial)
  • Zoon balanitis: Several case reports describe erythroplasia of Queyrat with coexistent Zoon balanitis[5]
  • Co-infection with human papillomavirus (HPV) type 8 and carcinogenic genital HPV types[6]
  • Other physical factors (eg, heat, friction, trauma)
  • Immunosuppression from organ transplantation, systemic infections or disease (HIV), and medications (prednisone, immunosuppressants): These factors may contribute to an increased overall incidence and to invasive disease in affected patients.
  • UV light radiation/phototherapy
  • Phimosis
  • Multiple sexual partners (increase risk of HPV infection)
  • Smoking
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Contributor Information and Disclosures
Author

Kendall M Egan, MD  Resident Physician, Department of Dermatology, Naval Medical Center San Diego

Kendall M Egan, MD is a member of the following medical societies: American Academy of Dermatology, California Society of Dermatology and Dermatologic Surgery, and Pacific Dermatologic Association

Disclosure: Nothing to disclose.

Coauthor(s)

Kimberly L Maino, MD  Head, Dermatologic Surgery/Oncology, Mohs Micrographic Surgery, Department of Dermatology, Naval Medical Center San Diego

Kimberly L Maino, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Medical Association, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mark W Cobb, MD  Consulting Staff, WNC Dermatological Associates

Mark W Cobb, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and American Society of Dermatopathology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Mary Farley, MD  Dermatologic Surgeon/Mohs Surgeon, Anne Arundel Surgery Center

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Goette DK. Review of erythroplasia of Queyrat and its treatment. Urology. Oct 1976;8(4):311-5. [Medline].

  2. Micali G, Innocenzi D, Nasca MR, Musumeci ML, Ferrau F, Greco M. Squamous cell carcinoma of the penis. J Am Acad Dermatol. Sep 1996;35(3 Pt 1):432-51. [Medline].

  3. Graham JH, Helwig EB. Erythroplasia of Queyrat. A clinicopathologic and histochemical study. Cancer. Dec 1973;32(6):1396-414. [Medline].

  4. Kim B, Garcia F, Toma N, et al. A rare case of penile cancer in siu metastasizing to lymph nodes. Can Urol Assoc J. 2007;1:404-7.

  5. Divakaruni AK, Rao AV, Mahabir B. Erythroplasia of Queyrat with Zoon's balanitis: a diagnostic dilemma. Int J STD AIDS. Dec 2008;19(12):861-3. [Medline].

  6. Wieland U, Jurk S, Weissenborn S, Krieg T, Pfister H, Ritzkowsky A. Erythroplasia of queyrat: coinfection with cutaneous carcinogenic human papillomavirus type 8 and genital papillomaviruses in a carcinoma in situ. J Invest Dermatol. Sep 2000;115(3):396-401. [Medline].

  7. Harrington KJ, Price PM, Fry L, Witherow RO. Erythroplasia of Queyrat treated with isotretinoin. Lancet. Oct 16 1993;342(8877):994-5. [Medline].

  8. Micali G, Nasca MR, De Pasquale R. Erythroplasia of Queyrat treated with imiquimod 5% cream. J Am Acad Dermatol. Nov 2006;55(5):901-3. [Medline].

  9. Conejo-Mir JS, Munoz MA, Linares M, Rodriguez L, Serrano A. Carbon dioxide laser treatment of erythroplasia of Queyrat: a revisited treatment to this condition. J Eur Acad Dermatol Venereol. Sep 2005;19(5):643-4. [Medline].

  10. Arlette JP. Treatment of Bowen's disease and erythroplasia of Queyrat. Br J Dermatol. Nov 2003;149 Suppl 66:43-9. [Medline].

  11. Orengo I, Rosen T, Guill CK. Treatment of squamous cell carcinoma in situ of the penis with 5% imiquimod cream: a case report. J Am Acad Dermatol. Oct 2002;47(4 Suppl):S225-8. [Medline].

  12. Gerber GS. Carcinoma in situ of the penis. J Urol. Apr 1994;151(4):829-33. [Medline].

  13. Brown MD, Zachary CB, Grekin RC, Swanson NA. Genital tumors: their management by micrographic surgery. J Am Acad Dermatol. Jan 1988;18(1 Pt 1):115-22. [Medline].

  14. van Bezooijen BP, Horenblas S, Meinhardt W, Newling DW. Laser therapy for carcinoma in situ of the penis. J Urol. Nov 2001;166(5):1670-1. [Medline].

  15. Lee MR, Ryman W. Erythroplasia of Queyrat treated with topical methyl aminolevulinate photodynamic therapy. Australas J Dermatol. Aug 2005;46(3):196-8. [Medline].

  16. Davis-Daneshfar A, Trueb RM. Bowen's disease of the glans penis (erythroplasia of Queyrat) in plasma cell balanitis. Cutis. Jun 2000;65(6):395-8. [Medline].

  17. Porter WM, Francis N, Hawkins D, Dinneen M, Bunker CB. Penile intraepithelial neoplasia: clinical spectrum and treatment of 35 cases. Br J Dermatol. Dec 2002;147(6):1159-65. [Medline].

 
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Erythroplasia of Queyrat. Courtesy of Hon Pak, MD.
 
 
 
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