eMedicine Specialties > Dermatology > Malignant Neoplasms
Erythroplasia of Queyrat (Bowen Disease of the Glans Penis)
Updated: Jan 15, 2008
Introduction
Background
Erythroplasia of Queyrat (EQ) originally was described by Tarnovsky in 1891 and subsequently was appreciated as a penile disease by Fournier and Darier in 1893. More intensive studies by Queyrat in 1911 allowed this condition to be accepted as a distinct entity. He described erythroplasia of the glans penis and concluded that the disease represented a precancerous process.
Pathophysiology
EQ arises from the squamous epithelial cells of the glans penis or inner lining of the prepuce. It is seen almost exclusively in uncircumcised men and represents an in situ form of squamous cell carcinoma. Progression to invasive carcinoma may occur after a variable period of time.
Frequency
United States
EQ is a rare disorder in the United States. The exact prevalence is not well documented in the medical literature.
Mortality/Morbidity
EQ is treatable if underlying invasive carcinoma does not exist; however, as many as 10% of patients with EQ may have invasive squamous cell carcinoma in the primary lesion. Extension of cancerous cells into the submucosa is associated with a 20% incidence of regional lymph node metastases.
Sex
EQ occurs only in men.
Age
Median age of onset is 51 years. EQ has been described in men aged 20-80 years.1
Clinical
History
Characteristic lesions of EQ are solitary or multiple erythematous plaques. The texture can be smooth, velvety, scaly, or verrucous. The condition almost always involves the glans penis or adjacent mucosal surfaces or both. EQ lesions may be regarded as synonymous with penile Bowen disease or as representative of one end of a spectrum of in situ penile carcinoma. Both may represent forms of papillomavirus-induced carcinoma in situ.
- Presenting symptoms can vary and may include the following:
- Redness
- Crusting
- Scaling
- Ulceration
- Bleeding
- Pain
- Itching
- Dysuria
- Penile discharge
- Difficulty retracting the foreskin
Physical
Solitary or multiple cutaneous lesions may be present. Typically, minimally raised, erythematous plaques with variable texture are seen. The plaques may be smooth, velvety, scaly, crusty, or verrucous. Ulceration or distinct papillomatous papules within a plaque may indicate progression to invasive squamous cell carcinoma.
Causes
EQ most often occurs in uncircumcised men. Multiple factors have been implicated as causative agents in this process.
- Chronic irritation, inflammation, and infection appear to be the common links. A recent case report described a patient with coexistent Zoon balanitis.2
- Urine, smegma, or poor hygiene can cause chronic irritation of the area.
- Other physical factors, such as heat, friction, and trauma, also have been implicated.
- Chronic infections, such as herpes simplex and human papillomavirus,3 are other considerations.
- Immunosuppression from allogenic organ transplantation may contribute to increased overall incidence and invasive disease in affected patients.
- Consider a broad differential diagnosis with cutaneous penile lesions. All types of inflammatory, infectious, and neoplastic processes can occur in this area. A systematic approach is crucial.
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| Treatment & Medication: Erythroplasia of Queyrat (Bowen Disease of the Glans Penis) |
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References
Goette DK. Review of erythroplasia of Queyrat and its treatment. Urology. Oct 1976;8(4):311-5. [Medline].
Davis-Daneshfar A, Trüeb RM. Bowen's disease of the glans penis (erythroplasia of Queyrat) in plasma cell balanitis. Cutis. Jun 2000;65(6):395-8. [Medline].
Arlette JP. Treatment of Bowen's disease and erythroplasia of Queyrat. Br J Dermatol. Nov 2003;149 Suppl 66:43-9. [Medline].
Harrington KJ, Price PM, Fry L, Witherow RO. Erythroplasia of Queyrat treated with isotretinoin. Lancet. Oct 16 1993;342(8877):994-5. [Medline].
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].
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].
Lee MR, Ryman W. Erythroplasia of Queyrat treated with topical methyl aminolevulinate photodynamic therapy. Australas J Dermatol. Aug 2005;46(3):196-8. [Medline].
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].
Conejo-Mir JS, Muñoz MA, Linares M, Rodríguez 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].
Gerber GS. Carcinoma in situ of the penis. J Urol. Apr 1994;151(4):829-33. [Medline].
Graham JH, Helwig EB. Erythroplasia of Queyrat. A clinicopathologic and histochemical study. Cancer. Dec 1973;32(6):1396-414. [Medline].
Further Reading
Keywords
carcinoma in situ of the penis, Bowen disease, penile carcinoma, penile neoplasia, EQ, erythroplasia of the glans penis, uncircumcised men, erythematous plaques, penile Bowen disease, papillomavirus-induced carcinoma in situ
