eMedicine Specialties > Dermatology > Malignant Neoplasms

Erythroplasia of Queyrat (Bowen Disease of the Glans Penis): Treatment & Medication

Author: Joseph L Wilde, MD, Mohs Micrographic Surgery, Chief, Department of Dermatology, Brooke Army Medical Center
Contributor Information and Disclosures

Updated: Jan 15, 2008

Treatment

Medical Care

Selected cases of EQ have been treated successfully using 5-fluorouracil.1 Interestingly, another report showed temporary resolution using oral isotretinoin, but the lesion recurred after discontinuation of the medication.4

Case reports have shown imiquimod (Aldara) to have potential efficacy in the treatment of EQ.3,5,6 Larger placebo-controlled studies are needed to confirm this initial data. Finally, photodynamic therapy is also a promising modality.7

Surgical Care

Mohs micrographic surgery has proven to be the surgical treatment of choice in EQ.8 Other modalities reported to treat EQ successfully include the following:

  • Cryotherapy
  • Electrodesiccation and curettage
  • Carbon dioxide laser ablation9

Medication

Antineoplastic agents

Several case reports describe limited success in treating selected superficial lesions of EQ with topical 5% 5-fluorouracil cream.


Fluorouracil (Efudex)

Disrupts DNA synthesis by stopping the methylation of deoxyuridylic acid and inhibiting thymidylate synthetase, thereby halting cell proliferation.

Adult

Apply cream to affected areas bid for minimum of 4 wk; longer treatment schedules may be required depending on depth and diameter of individual lesions

Pediatric

Not established

Documented hypersensitivity; potentially serious infections

Pregnancy

X - Contraindicated; benefit does not outweigh risk

Precautions

Avoid exposing treated area to UV radiation; incidence of inflammatory reactions may occur with occlusive dressings; porous gauze dressing may be applied for cosmetic reasons without increase in reaction; patients should expect inflammatory reaction with crusting

Immune response modifiers

Several case reports and series describe successful treatment of non-invasive EQ with topical imiquimod 5% cream.


Imiquimod (Aldara)

Immune response modifier that induces local activity of cytokines to include interferon alpha. Specific mechanism of action unknown.

Adult

Various topical dosing regimens have been used in reported cases; duration of treatment should be long enough to induce some degree of local response clinically, as indicated by erythema, crusting, or superficial erosion
Reported cases achieved local response after 3-12 wk of treatment dosed qod or 3 times per wk; rest period of 3-7 d may be needed mid cycle to allow healing of erosions or decrease local pain/pruritus
Optimum dosing schedule and length of treatment have not yet been determined by large-scale studies

Pediatric

Not established

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Genital use: Not recommended for treatment of rectal, cervical, intravaginal, urethral, and intra-anal human papilloma infection; following surgery or drug treatment, do not use topical imiquimod until genital/perianal tissue is healed
Actinic keratosis: Avoid exposure to sunlight or artificial tanning; regular use of sunscreen is encouraged; avoid contact with lips, eyes, or nostrils; common adverse effects include erythema, edema, vesicles, erosion or ulceration, weeping, exudate, flaking, scaling, dryness, and scabbing or crusting
Basal cell carcinoma: Medical follow-up is essential to assure cancer has responded adequately to treatment; may cause redness, swelling, and sore development at application site; may cause itching or burning

More on Erythroplasia of Queyrat (Bowen Disease of the Glans Penis)

Overview: Erythroplasia of Queyrat (Bowen Disease of the Glans Penis)
Differential Diagnoses & Workup: Erythroplasia of Queyrat (Bowen Disease of the Glans Penis)
Treatment & Medication: Erythroplasia of Queyrat (Bowen Disease of the Glans Penis)
Follow-up: Erythroplasia of Queyrat (Bowen Disease of the Glans Penis)
Multimedia: Erythroplasia of Queyrat (Bowen Disease of the Glans Penis)
References
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References

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

  2. 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].

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

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

  5. 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].

  6. 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].

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

  8. 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].

  9. 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].

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

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

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Further Reading

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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

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Contributor Information and Disclosures

Author

Joseph L Wilde, MD, Mohs Micrographic Surgery, Chief, Department of Dermatology, Brooke Army Medical Center
Joseph L Wilde, MD is a member of the following medical societies: American College of Mohs Micrographic Surgery and Cutaneous Oncology
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

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.

Managing Editor

Mary Farley, MD, Dermatologic Surgeon/Mohs Surgeon, Department of Dermatology, The Skin Surgery Center
Disclosure: Nothing to disclose.

CME Editor

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: Nothing to disclose.

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.

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