eMedicine Specialties > Dermatology > Malignant Neoplasms

Penile Squamous Cell Carcinoma: Differential Diagnoses & Workup

Author: Giuseppe Micali, MD, Head, Professor, Department of Dermatology, University of Catania School of Medicine, Italy
Coauthor(s): Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School; Maria R Nasca, MD, PhD, Assistant Professor, Department of Dermatology, University of Catania School of Medicine, Italy
Contributor Information and Disclosures

Updated: Mar 5, 2009

Differential Diagnoses

Erythroplasia of Queyrat (Bowen Disease of the Glans Penis)
Metastatic Carcinoma of the Skin
Verruciform Xanthoma
Verrucous Carcinoma
Warts, Genital

Workup

Laboratory Studies

  • Hypercalcemia may rarely complicate a penile carcinoma.61

Imaging Studies

  • Imaging techniques recommended for a more accurate staging of neoplastic disease and for periodic follow-up of treated patients include ultrasonography, CT scanning, and MRI.62
    • Ultrasonography has the advantages of low cost, noninvasiveness, easy availability, and reliability in assessing extension of the primary tumor and of lymph nodes. Ultrasonographic evaluation may also have a role in determining whether metastatic nodes are resectable.
    • CT scanning is widely performed in the staging of lymph nodes, but it is of limited help in the assessment of penile lesions.
    • MRI improves soft tissue contrast and provides multiplanar high-resolution images, yielding the greatest accuracy in the evaluation of both the penile primary tumor and the lymph nodes.63
  • Autofluorescence studies and 5-aminolevulinic acid–induced fluorescence studies have been suggested as promising tools for planning adequate laser ablation of superficial tumors.64 However, none of these techniques is able to detect occult lymph node micrometastases.
  • Lymphangiography and cavernosography have fallen out of favor because of their invasiveness.
  • Lymphoscintigraphy may be performed to identify sentinel nodes and to establish the need for lymph node dissection.48,65,66,67
  • Positron emission tomography may be able to provide early evidence of metastatic disease.68

Other Tests

  • Initial biopsy of the primary penile lesion is necessary to confirm the diagnosis and to assess the grade and the invasiveness of the tumor, although a 2004 study has shown that it may fail to correctly assess the histologic grade (30% of cases) and deepest point of tumor invasion (91% of cases) when used alone.56 Biopsy usually consists of a 1-cm elliptical wedge excision centered on the margin of the lesion. The mucosal application of 1% toluidine blue may aid in the identification of the best area from which to obtain a biopsy specimen.5
  • In the diagnosis of long-standing, ulcerating condylomata, the identification of HPV DNA by using molecular hybridization techniques (eg, Southern blotting, dot blotting, in situ hybridization, PCR) may be a useful diagnostic adjunct because lesions harboring oncogenic HPVs are reported to be at high risk of malignant degeneration.
  • Detection of a serum SCC antigen marker (SCCAg) may be a useful adjunctive tool to monitor treatment response, but this is still a controversial issue.69,70
  • Because these investigations are expensive, their use should be reserved for selected cases.

Histologic Findings

Histopathologic examination is essential to establish the diagnosis and to provide information about the extension of the tumor in deeper tissues.71,72

Upon microscopy, SCC may have different histologic features according to the degree of differentiation.

Broders has described a classification of 4 groups with increasing aspects of atypia.9 The grading of SCC in the Broders systems is as follows:

  • Grade I
    • Cells well differentiated with keratinization
    • Prominent intercellular bridges
    • Keratin pearls
  • Grade II-III
    • Greater nuclear atypia
    • Increased mitotic activity
    • Fewer keratin pearls
  • Grade IV
    • Marked nuclear pleomorphism
    • Numerous mitoses
    • Necrosis
    • Lymphatic and perineural invasion
    • No keratin pearls
    • Deeply invasive

Low-grade (grades I-II), well-differentiated lesions show a thickened, hyperkeratotic, and papillomatous epidermis, with a downward, fingerlike projection of atypical squamous cells, which often appear as concentrically arranged nests of cells surrounding keratin accumulations (keratin pearls). Epithelial cells show intact desmosomes and slight atypia, with enlarged and pleomorphic nuclei and 1 or more prominent nucleoli. Mitotic figures are present. Individual cells may become dyskeratotic, appearing deeply eosinophilic. In the dermis, a dense lymphocytic or mixed inflammatory infiltrate may be present.9

Poorly differentiated SCC (grades III-IV) shows little or no keratinization, increased nuclear pleomorphism and hyperchromasia, and deeper invasion, and it may have areas of necrosis or superinfection.9

Several histologic subsets of SCC have been identified.5 These include, besides the usual variant (most common subtype, accounting for almost 60%),73 the verruciform variant (including warty/condylomatous, papillary/not otherwise specified, and verrucous types),72 the pseudohyperplastic variant,74 the basaloid variant,72,73 sarcomatoid or spindle cell carcinoma,75,76 the adenosquamous variant,77,78 and the mixed variant. Identification of more unusual variants on biopsy is often challenging, and they are usually identified only in penectomy specimens.56

The histologic type seems to be correlated to its biologic behavior. HPV DNA positivity is only weakly associated (11%) with typically keratinizing SCC and is strongly correlated histopathologically with basaloid changes (75%).28,79,80 Moreover, well-differentiated, low-grade keratinizing tumors, including the papillary/not otherwise specified and pseudohyperplastic variants, occur in older patients and are usually associated with preexisting lichen sclerosus74 and a low risk of metastatic spread. Conversely, warty and/or condylomatous and basaloid tumors are consistently associated with HPV infection and with aggressive growth and a poor prognosis. SCC of the usual type holds an intermediate position with regard to depth of invasion, metastatic potential, and prognosis.72,81,82

In verrucous carcinoma, morphologically warty or verrucous, the relatively bland histologic features are often more suggestive of verruca vulgaris or pseudoepitheliomatous hyperplasia than of SCC to those unfamiliar with the diagnosis.6,7 Histologic examination shows massive hyperplasia of the epidermis, with marked hyperkeratosis and parakeratosis. The granular layer is prominent, with vacuolated cells that resemble the koilocytes of condyloma acuminatum. The individual keratinocytes have a large amount of cytoplasm and a large nucleus with prominent nucleoli. Atypical mitotic figures, individual cell necrosis, dyskeratosis, and multinucleated keratinocytes are rare.

Intracytoplasmic glycogen is scant. Tumor projections appear as blunt masses that extend into the dermis and the deep structures to form sinuses and keratin-filled cysts. Centripetal keratinization is often present, but horn pearls are not present. A marked inflammatory lymphohistiocytic infiltrate is usually observed. Tumor cells are not found in blood vessels or lymphatics; this finding is presumably correlated with the lack of metastases.3,6,7

Staging

Assessment of histologic grade and infiltration or invasion of the adjacent deep or lateral tissues aids in planning treatment.

Clinical staging is not always reliable because tumors apparently limited to the glans and the prepuce can be understaged upon histologic examination. Moreover, a comparison of relevant pathologic parameters between incisional biopsy and penectomy specimens from the same patients with penile SCC showed that the former may be insufficient for correctly assessing the histologic grade and deepest point of tumor invasion.56 Therefore, additional information obtained with complementary imaging techniques should be evaluated for accurate staging of neoplastic disease.

Clinical assessment of inguinal node metastases is also often difficult. When inguinal lymph node enlargement persists after a course of oral antibiotics, thorough imaging and histologic examinations are suggested.

The staging systems currently used are the Jackson classification and the tumor, nodes, metastases (TNM) system (Union Internationale Contre le Cancer).65,83 The current TNM staging system was questioned in 2008.84

  • Jackson classification for SCC of the penis
    • Stage I - Tumor confined to the glans or the prepuce
    • Stage II - Invasion into the shaft or the corpora; no nodal or distant metastases
    • Stage III - Tumor confined to the penis; operable metastases of the inguinal nodes
    • Stage IV - Tumor involves adjacent structures; inoperable inguinal nodes and/or distant metastasis or metastases
  • TNM classification for SCC of the penis
    • Tumor
      • TX - Not defined
      • T0 - No evidence of primary tumor
      • Tis - Carcinoma in situ (Bowen disease, erythroplasia of Queyrat)
      • Ta - Noninvasive verrucous carcinoma
      • T1 - Tumor invading the subepithelial connective tissue
      • T2 - Tumor invading the corpus spongiosum or cavernosum
      • T3 - Tumor invading urethra or prostate
      • T4 - Tumor invading other adjacent structures
    • Node
      • NX - Not defined
      • N0 - No evidence of regional node involvement
      • N1 - Involvement of a single superficial inguinal node
      • N2 - Involvement of multiple or bilateral superficial inguinal nodes
      • N3 - Involvement of deep inguinal or pelvic nodes, unilateral or bilateral
    • Metastasis
      • MX - Not defined
      • M0 - No evidence of distant metastasis
      • M1 - Distant metastasis present
      • M1a - Occult metastasis (biochemical and/or other tests)
      • M1b - Single metastasis in a single organ
      • M1c - Multiple metastasis in a single organ
      • M1d - Metastasis in multiple organ sites

More on Penile Squamous Cell Carcinoma

Overview: Penile Squamous Cell Carcinoma
Differential Diagnoses & Workup: Penile Squamous Cell Carcinoma
Treatment & Medication: Penile Squamous Cell Carcinoma
Follow-up: Penile Squamous Cell Carcinoma
Multimedia: Penile Squamous Cell Carcinoma
References
[ CLOSE WINDOW ]

References

  1. Agarwal P, Sharma D. Autodestruction of penis due to carcinoma. J Eur Acad Dermatol Venereol. Mar 2005;19(2):220-2. [Medline].

  2. Jaganmohan S, Khurana V, Nopajaroonsri C. Squamous cell carcinoma of the penis presenting as a sterile inguinal abscess. J Urol. Nov 2004;172(5 Pt 1):1877. [Medline].

  3. 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].

  4. Micali G, Nasca MR, Innocenzi D, Schwartz RA. Invasive penile carcinoma: a review. Dermatol Surg. Feb 2004;30(2 Pt 2):311-20. [Medline].

  5. Micali G, Nasca MR, Innocenzi D, Schwartz RA. Penile cancer. J Am Acad Dermatol. Mar 2006;54(3):369-91; quiz 391-4. [Medline].

  6. Schwartz RA. Buschke-Loewenstein tumor: verrucous carcinoma of the penis. J Am Acad Dermatol. Oct 1990;23(4 Pt 1):723-7. [Medline].

  7. Schwartz RA. Verrucous carcinoma of the skin and mucosa. J Am Acad Dermatol. Jan 1995;32(1):1-21; quiz 22-4. [Medline].

  8. Cubilla AL, Velazques EF, Reuter VE, Oliva E, Mihm MC Jr, Young RH. Warty (condylomatous) squamous cell carcinoma of the penis: a report of 11 cases and proposed classification of 'verruciform' penile tumors. Am J Surg Pathol. Apr 2000;24(4):505-12. [Medline].

  9. Lucia MS, Miller GJ. Histopathology of malignant lesions of the penis. Urol Clin North Am. May 1992;19(2):227-46. [Medline].

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

  11. Kim B, Garcia F, Touma N, Moussa M, Izawa JI. A rare case of penile cancer in situ metastasizing to lymph nodes. Can Urol Assoc J. Nov 2007;1(4):404-7. [Medline].

  12. Papadopoulos AJ, Schwartz RA, Lefkowitz A, Tinkle LL, Janniger CK, Lambert WC. Extragenital bowenoid papulosis associated with atypical human papillomavirus genotypes. J Cutan Med Surg. Mar-Apr 2002;6(2):117-21. [Medline].

  13. Schwartz RA, Janniger CK. Bowenoid papulosis. J Am Acad Dermatol. Feb 1991;24(2 Pt 1):261-4. [Medline].

  14. Schellhammer PF, Jordan GH, Robey EL, Spaulding JT. Premalignant lesions and nonsquamous malignancy of the penis and carcinoma of the scrotum. Urol Clin North Am. Feb 1992;19(1):131-42. [Medline].

  15. Mikhail GR. Cancers, precancers, and pseudocancers on the male genitalia. A review of clinical appearances, histopathology, and management. J Dermatol Surg Oncol. Dec 1980;6(12):1027-35. [Medline].

  16. Bleeker MC, Hogewoning CJ, Van Den Brule AJ, et al. Penile lesions and human papillomavirus in male sexual partners of women with cervical intraepithelial neoplasia. J Am Acad Dermatol. Sep 2002;47(3):351-7. [Medline].

  17. Madsen BS, van den Brule AJ, Jensen HL, Wohlfahrt J, Frisch M. Risk factors for squamous cell carcinoma of the penis--population-based case-control study in Denmark. Cancer Epidemiol Biomarkers Prev. Oct 2008;17(10):2683-91. [Medline].

  18. Scheiner MA, Campos MM, Ornellas AA, Chin EW, Ornellas MH, Andrada-Serpa MJ. Human papillomavirus and penile cancers in Rio de Janeiro, Brazil: HPV typing and clinical features. Int Braz J Urol. Jul-Aug 2008;34(4):467-74; discussion 475-6. [Medline].

  19. Iwasawa A, Kumamoto Y, Fujinaga K. Detection of human papillomavirus deoxyribonucleic acid in penile carcinoma by polymerase chain reaction and in situ hybridization. J Urol. Jan 1993;149(1):59-63. [Medline].

  20. Rosemberg SK. Sexually transmitted papillomaviral infection in men. An update. Dermatol Clin. Apr 1991;9(2):317-31. [Medline].

  21. Nasca MR, Innocenzi D, Micali G. Penile cancer among patients with genital lichen sclerosus. J Am Acad Dermatol. Dec 1999;41(6):911-4. [Medline].

  22. Rubin MA, Kleter B, Zhou M, et al. Detection and typing of human papillomavirus DNA in penile carcinoma: evidence for multiple independent pathways of penile carcinogenesis. Am J Pathol. Oct 2001;159(4):1211-8. [Medline].

  23. Micali G, Nasca MR, Innocenzi D. Lichen sclerosus of the glans is significantly associated with penile carcinoma. Sex Transm Infect. Jun 2001;77(3):226. [Medline].

  24. Powell J, Robson A, Cranston D, et al. High incidence of lichen sclerosus in patients with squamous cell carcinoma of the penis. Br J Dermatol. Jul 2001;145(1):85-9. [Medline].

  25. Perceau G, Derancourt C, Clavel C, et al. Lichen sclerosus is frequently present in penile squamous cell carcinomas but is not always associated with oncogenic human papillomavirus. Br J Dermatol. May 2003;148(5):934-8. [Medline].

  26. Pietrzak P, Hadway P, Corbishley CM, Watkin NA. Is the association between balanitis xerotica obliterans and penile carcinoma underestimated?. BJU Int. Jul 2006;98(1):74-6. [Medline].

  27. Barbagli G, Palminteri E, Mirri F, Guazzoni G, Turini D, Lazzeri M. Penile carcinoma in patients with genital lichen sclerosus: a multicenter survey. J Urol. Apr 2006;175(4):1359-63. [Medline].

  28. Velazquez EF, Cubilla AL. Lichen sclerosus in 68 patients with squamous cell carcinoma of the penis: frequent atypias and correlation with special carcinoma variants suggests a precancerous role. Am J Surg Pathol. Nov 2003;27(11):1448-53. [Medline].

  29. Nasca MR, Innocenzi D, Micali G. Association of penile lichen sclerosus and oncogenic human papillomavirus infection. Int J Dermatol. Jun 2006;45(6):681-3. [Medline].

  30. Gray MR, Ansell ID. Pseudo-epitheliomatous hyperkeratotic and micaceous balanitis: evidence for regarding it as pre-malignant. Br J Urol. Jul 1990;66(1):103-4. [Medline].

  31. Solivan GA, Smith KJ, James WD. Cutaneous horn of the penis: its association with squamous cell carcinoma and HPV-16 infection. J Am Acad Dermatol. Nov 1990;23(5 Pt 2):969-72. [Medline].

  32. Cruz Guerra NA, Saenz Medina J, Ursua Sarmiento I, et al. [Malignant recurrence of a penile cutaneous horn]. Arch Esp Urol. Jan-Feb 2005;58(1):61-3. [Medline].

  33. Saibishkumar EP, Crook J, Sweet J. Neonatal circumcision and invasive squamous cell carcinoma of the penis: a report of 3 cases and a review of the literature. Can Urol Assoc J. Feb 2008;2(1):39-42. [Medline].

  34. Dennis EJ, Heins HC, Latham E, Mciver FA, Pratt-Thomas HR. The carcinogenic effect of human smegma: an experimental study. I. Preliminary report. Cancer. Jul-Aug 1956;9(4):671-80. [Medline].

  35. Castellsague X, Bosch FX, Munoz N, et al. Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. N Engl J Med. Apr 11 2002;346(15):1105-12. [Medline].

  36. Tsen HF, Morgenstern H, Mack T, Peters RK. Risk factors for penile cancer: results of a population-based case-control study in Los Angeles County (United States). Cancer Causes Control. Apr 2001;12(3):267-77. [Medline].

  37. Rogus BJ. Squamous cell carcinoma in a young circumcised man. J Urol. Oct 1987;138(4):861-2. [Medline].

  38. Thomas MA, Nangia AK. Squamous cell carcinoma of the penis following penile trauma. J Urol. Jan 2004;171(1):341-2. [Medline].

  39. Kakinuma H, Miyakawa K, Baba S, Suzuki H, Kawada N, Takimoto Y. Penile cancer associated with an artificial penile nodule. Acta Derm Venereol. Sep 1994;74(5):412-3. [Medline].

  40. Seyam RM, Bissada NK, Mokhtar AA, et al. Outcome of penile cancer in circumcised men. J Urol. Feb 2006;175(2):557-61; discussion 561. [Medline].

  41. Hellberg D, Valentin J, Eklund T, Nilsson S. Penile cancer: is there an epidemiological role for smoking and sexual behaviour?. Br Med J (Clin Res Ed). Nov 21 1987;295(6609):1306-8. [Medline].

  42. Stern RS, Bagheri S, Nichols K. The persistent risk of genital tumors among men treated with psoralen plus ultraviolet A (PUVA) for psoriasis. J Am Acad Dermatol. Jul 2002;47(1):33-9. [Medline].

  43. Fryrear RS 2nd, Wiggins AK, Sangueza O, Yosipovitch G. Rapid onset of cutaneous squamous cell carcinoma of the penis in a patient with psoriasis on etanercept therapy. J Am Acad Dermatol. Dec 2004;51(6):1026. [Medline].

  44. Poblet E, Alfaro L, Fernander-Segoviano P, Jimenez-Reyes J, Salido EC. Human papillomavirus-associated penile squamous cell carcinoma in HIV-positive patients. Am J Surg Pathol. Sep 1999;23(9):1119-23. [Medline].

  45. Harder Y, Erni D, Banic A. Squamous cell carcinoma of the penile skin in a neovagina 20 years after male-to-female reassignment. Br J Plast Surg. Jul 2002;55(5):449-51. [Medline].

  46. Bain L, Geronemus R. The association of lichen planus of the penis with squamous cell carcinoma in situ and with verrucous squamous carcinoma. J Dermatol Surg Oncol. Apr 1989;15(4):413-7. [Medline].

  47. Child FJ, Kim BK, Ganesan R, Southern SA, Herrington CS, Calonje E. Verrucous carcinoma arising in pseudoepitheliomatous keratotic and micaceous balanitis, without evidence of human papillomavirus. Br J Dermatol. Jul 2000;143(1):183-7. [Medline].

  48. Burgers JK, Badalament RA, Drago JR. Penile cancer. Clinical presentation, diagnosis, and staging. Urol Clin North Am. May 1992;19(2):247-56. [Medline].

  49. Narayana AS, Olney LE, Loening SA, Weimar GW, Culp DA. Carcinoma of the penis: analysis of 219 cases. Cancer. May 15 1982;49(10):2185-91. [Medline].

  50. Carver BS, Mata JA, Venable DD, Eastham JA. Squamous cell carcinoma of the penis: a retrospective review of forty-five patients in northwest Louisiana. South Med J. Aug 2002;95(8):822-5. [Medline].

  51. Barnholtz-Sloan JS, Maldonado JL, Pow-sang J, Giuliano AR. Incidence trends in primary malignant penile cancer. Urol Oncol. Sep-Oct 2007;25(5):361-7. [Medline].

  52. Mistry T, Jones RW, Dannatt E, Prasad KK, Stockdale AD. A 10-year retrospective audit of penile cancer management in the UK. BJU Int. Dec 2007;100(6):1277-81. [Medline].

  53. Rippentrop JM, Joslyn SA, Konety BR. Squamous cell carcinoma of the penis: evaluation of data from the surveillance, epidemiology, and end results program. Cancer. Sep 15 2004;101(6):1357-63. [Medline].

  54. Goodman MT, Hernandez BY, Shvetsov YB. Demographic and pathologic differences in the incidence of invasive penile cancer in the United States, 1995-2003. Cancer Epidemiol Biomarkers Prev. Sep 2007;16(9):1833-9. [Medline].

  55. Aynaud O, Asselain B, Bergeron C, et al. [Intraepithelial carcinoma and invasive carcinoma of the vulva, vagina and penis in Ile-de-france. Enquete PETRI on 423 cases]. Ann Dermatol Venereol. May 2000;127(5):479-83. [Medline].

  56. Velazquez EF, Barreto JE, Rodriguez I, Piris A, Cubilla AL. Limitations in the interpretation of biopsies in patients with penile squamous cell carcinoma. Int J Surg Pathol. Apr 2004;12(2):139-46. [Medline].

  57. Khandpur S, Reddy BS, Kaur H. Multiple cutaneous metastases from carcinoma of the penis. J Dermatol. May 2002;29(5):296-9. [Medline].

  58. Giesler EJ, Gee JR, Reece GP, Pettaway CA, Pollock RE, Pisters LL. Cutaneous metastases of penile squamous cell carcinoma following en bloc resection of inguinal recurrence with immediate pedicle flap reconstruction. J Urol. Oct 2001;166(4):1384-5. [Medline].

  59. Solsona E, Iborra I, Rubio J, Casanova JL, Ricos JV, Calabuig C. Prospective validation of the association of local tumor stage and grade as a predictive factor for occult lymph node micrometastasis in patients with penile carcinoma and clinically negative inguinal lymph nodes. J Urol. May 2001;165(5):1506-9. [Medline].

  60. Slaton JW, Morgenstern N, Levy DA, et al. Tumor stage, vascular invasion and the percentage of poorly differentiated cancer: independent prognosticators for inguinal lymph node metastasis in penile squamous cancer. J Urol. Apr 2001;165(4):1138-42. [Medline].

  61. Ayyathurai R, Webb DB, Rowland S, Stephenson TP, Thomas AJ. Humoral hypercalcemia of penile carcinoma. Urology. Jan 2007;69(1):184.e9-10. [Medline].

  62. Misra S, Chaturvedi A, Misra NC. Penile carcinoma: a challenge for the developing world. Lancet Oncol. Apr 2004;5(4):240-7. [Medline].

  63. Kayes O, Minhas S, Allen C, Hare C, Freeman A, Ralph D. The role of magnetic resonance imaging in the local staging of penile cancer. Eur Urol. May 2007;51(5):1313-8; discussion 1318-9. [Medline].

  64. Frimberger D, Schneede P, Hungerhuber E, et al. Autofluorescence and 5-aminolevulinic acid induced fluorescence diagnosis of penile carcinoma -- new techniques to monitor Nd:YAG laser therapy. Urol Res. Oct 2002;30(5):295-300. [Medline].

  65. Vapnek JM, Hricak H, Carroll PR. Recent advances in imaging studies for staging of penile and urethral carcinoma. Urol Clin North Am. May 1992;19(2):257-66. [Medline].

  66. Valdes Olmos RA, Tanis PJ, Hoefnagel CA, et al. Penile lymphoscintigraphy for sentinel node identification. Eur J Nucl Med. May 2001;28(5):581-5. [Medline].

  67. Tanis PJ, Lont AP, Meinhardt W, Olmos RA, Nieweg OE, Horenblas S. Dynamic sentinel node biopsy for penile cancer: reliability of a staging technique. J Urol. Jul 2002;168(1):76-80. [Medline].

  68. Leijte JA, Valdes Olmos RA, Mens JW, Horenblas S. Use of positron emission tomography in spindle cell carcinoma of the penis. Urology. Nov 2006;68(5):1121.e17-9. [Medline].

  69. Hungerhuber E, Schlenker B, Frimberger D, et al. Lymphoscintigraphy in penile cancer: limited value of sentinel node biopsy in patients with clinically suspicious lymph nodes. World J Urol. Aug 2006;24(3):319-24. [Medline].

  70. Zhu Y, Ye DW, Yao XD, et al. The value of squamous cell carcinoma antigen in the prognostic evaluation, treatment monitoring and followup of patients with penile cancer. J Urol. Nov 2008;180(5):2019-23. [Medline].

  71. Cubilla AL, Piris A, Pfannl R, Rodriguez I, Agüero F, Young RH. Anatomic levels: important landmarks in penectomy specimens: a detailed anatomic and histologic study based on examination of 44 cases. Am J Surg Pathol. Aug 2001;25(8):1091-4. [Medline].

  72. Cubilla AL, Reuter V, Velazquez E, Piris A, Saito S, Young RH. Histologic classification of penile carcinoma and its relation to outcome in 61 patients with primary resection. Int J Surg Pathol. Apr 2001;9(2):111-20. [Medline].

  73. Cubilla AL, Reuter VE, Gregoire L, et al. Basaloid squamous cell carcinoma: a distinctive human papilloma virus-related penile neoplasm: a report of 20 cases. Am J Surg Pathol. Jun 1998;22(6):755-61. [Medline].

  74. Cubilla AL, Velazquez EF, Young RH. Pseudohyperplastic squamous cell carcinoma of the penis associated with lichen sclerosus. An extremely well-differentiated, nonverruciform neoplasm that preferentially affects the foreskin and is frequently misdiagnosed: a report of 10 cases of a distinctive clinicopathologic entity. Am J Surg Pathol. Jul 2004;28(7):895-900. [Medline].

  75. Manglani KS, Manaligod JR, Ray B. Spindle cell carcinoma of the glans penis: a light and electron microscopic study. Cancer. Nov 15 1980;46(10):2266-72. [Medline].

  76. Shimamoto T, Iiyama T, Karashima T, et al. [A case of spindle cell carcinoma of the penis]. Hinyokika Kiyo. Nov 2005;51(11):775-8. [Medline].

  77. Cubilla AL, Ayala MT, Barreto JE, Bellasai JG, Noel JC. Surface adenosquamous carcinoma of the penis. A report of three cases. Am J Surg Pathol. Feb 1996;20(2):156-60. [Medline].

  78. Romero FR, de Castro MG, Garcia CR, Perez MD. Adenosquamous carcinoma of the penis. Clinics. Aug 2006;61(4):363-4. [Medline].

  79. Dillner J, von Krogh G, Horenblas S, Meijer CJ. Etiology of squamous cell carcinoma of the penis. Scand J Urol Nephrol Suppl. 2000;189-93. [Medline].

  80. Gross G, Pfister H. Role of human papillomavirus in penile cancer, penile intraepithelial squamous cell neoplasias and in genital warts. Med Microbiol Immunol. Feb 2004;193(1):35-44. [Medline].

  81. Bezerra AL, Lopes A, Santiago GH, Ribeiro KC, Latorre MR, Villa LL. Human papillomavirus as a prognostic factor in carcinoma of the penis: analysis of 82 patients treated with amputation and bilateral lymphadenectomy. Cancer. Jun 15 2001;91(12):2315-21. [Medline].

  82. Dai B, Ye DW, Kong YY, Yao XD, Zhang HL, Shen YJ. Predicting regional lymph node metastasis in Chinese patients with penile squamous cell carcinoma: the role of histopathological classification, tumor stage and depth of invasion. J Urol. Oct 2006;176(4 Pt 1):1431-5; discussion 1435. [Medline].

  83. Das S. Penile amputations for the management of primary carcinoma of the penis. Urol Clin North Am. May 1992;19(2):277-82. [Medline].

  84. Leijte JA, Horenblas S. Shortcomings of the current TNM classification for penile carcinoma: time for a change?. World J Urol. Aug 9 2008;[Medline].

  85. McDougal WS. Advances in the treatment of carcinoma of the penis. Urology. Nov 2005;66(5 Suppl):114-7. [Medline].

  86. Crook J, Grimard L, Tsihlias J, Morash C, Panzarella T. Interstitial brachytherapy for penile cancer: an alternative to amputation. J Urol. Feb 2002;167(2 Pt 1):506-11. [Medline].

  87. Azrif M, Logue JP, Swindell R, Cowan RA, Wylie JP, Livsey JE. External-beam radiotherapy in T1-2 N0 penile carcinoma. Clin Oncol (R Coll Radiol). May 2006;18(4):320-5. [Medline].

  88. Crook J, Ma C, Grimard L. Radiation therapy in the management of the primary penile tumor: an update. World J Urol. Jul 18 2008;[Medline].

  89. Sanchez-Ortiz RF, Pettaway CA. Natural history, management, and surveillance of recurrent squamous cell penile carcinoma: a risk-based approach. Urol Clin North Am. Nov 2003;30(4):853-67. [Medline].

  90. Zouhair A, Coucke PA, Jeanneret W, et al. Radiation therapy alone or combined surgery and radiation therapy in squamous-cell carcinoma of the penis?. Eur J Cancer. Jan 2001;37(2):198-203. [Medline].

  91. Ozsahin M, Jichlinski P, Weber DC, et al. Treatment of penile carcinoma: to cut or not to cut?. Int J Radiat Oncol Biol Phys. Nov 1 2006;66(3):674-9. [Medline].

  92. Guillet G, Foucher JM, Le Roy JP. [Spinocellular degeneration of an HPV 6 Buschke-Loewenstein tumor. Discussion of the concept of verrucous carcinoma]. Ann Dermatol Venereol. 1988;115(3):339-43. [Medline].

  93. Klein E. Tumors of skin. IX. Local cytostatic therapy of cutaneous and mucosal premalignant and malignant lesions. N Y State J Med. Apr 1 1968;68(7):886-9. [Medline].

  94. Taliaferro SJ, Cohen GF. Bowen's disease of the penis treated with topical imiquimod 5% cream. J Drugs Dermatol. May 2008;7(5):483-5. [Medline].

  95. 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].

  96. Pizzocaro G, Nicolai N, Milani A. Taxanes in Combination with Cisplatin and Fluorouracil for Advanced Penile Cancer: Preliminary Results. Eur Urol. Jul 14 2008;[Medline].

  97. Hakenberg OW, Nippgen JB, Froehner M, Zastrow S, Wirth MP. Cisplatin, methotrexate and bleomycin for treating advanced penile carcinoma. BJU Int. Dec 2006;98(6):1225-7. [Medline].

  98. Leijte JA, Kroon BK, Valdes Olmos RA, Nieweg OE, Horenblas S. Reliability and safety of current dynamic sentinel node biopsy for penile carcinoma. Eur Urol. Jul 2007;52(1):170-7. [Medline].

  99. Bermejo C, Busby JE, Spiess PE, Heller L, Pagliaro LC, Pettaway CA. Neoadjuvant chemotherapy followed by aggressive surgical consolidation for metastatic penile squamous cell carcinoma. J Urol. Apr 2007;177(4):1335-8. [Medline].

  100. Leijte JA, Kerst JM, Bais E, Antonini N, Horenblas S. Neoadjuvant chemotherapy in advanced penile carcinoma. Eur Urol. Aug 2007;52(2):488-94. [Medline].

  101. Axcrona K, Brennhovd B, Alfsen GC, Giercksky KE, Warloe T. Photodynamic therapy with methyl aminolevulinate for atypial carcinoma in situ of the penis. Scand J Urol Nephrol. 2007;41(6):507-10. [Medline].

  102. Kroon BK, Horenblas S, Lont AP, Tanis PJ, Gallee MP, Nieweg OE. Patients with penile carcinoma benefit from immediate resection of clinically occult lymph node metastases. J Urol. Mar 2005;173(3):816-9. [Medline].

  103. Loughlin KR. Surgical atlas. Surgical management of penile carcinoma: the inguinal nodes. BJU Int. May 2006;97(5):1125-34. [Medline].

  104. Anderson PC, Summerton DJ, Terry TR, Bracka A. Surgical management of penile carcinoma: the primary lesion. BJU Int. Aug 2006;98(2):464-5. [Medline].

  105. Palminteri E, Berdondini E, Lazzeri M, Mirri F, Barbagli G. Resurfacing and reconstruction of the glans penis. Eur Urol. Sep 2007;52(3):893-8. [Medline].

  106. Shindel AW, Mann MW, Lev RY, et al. Mohs micrographic surgery for penile cancer: management and long-term followup. J Urol. Nov 2007;178(5):1980-5. [Medline].

  107. Kroon BK, Horenblas S, Nieweg OE. Contemporary management of penile squamous cell carcinoma. J Surg Oncol. Jan 1 2005;89(1):43-50. [Medline].

  108. Tietjen DN, Malek RS. Laser therapy of squamous cell dysplasia and carcinoma of the penis. Urology. Oct 1998;52(4):559-65. [Medline].

  109. Frimberger D, Hungerhuber E, Zaak D, Waidelich R, Hofstetter A, Schneede P. Penile carcinoma. Is Nd:YAG laser therapy radical enough?. J Urol. Dec 2002;168(6):2418-21; discussion 2421. [Medline].

  110. Windahl T, Andersson SO. Combined laser treatment for penile carcinoma: results after long-term followup. J Urol. Jun 2003;169(6):2118-21. [Medline].

  111. Meijer RP, Boon TA, van Venrooij GE, Wijburg CJ. Long-term follow-up after laser therapy for penile carcinoma. Urology. Apr 2007;69(4):759-62. [Medline].

  112. Michelman FA, Filho AC, Moraes AM. Verrucous carcinoma of the penis treated with cryosurgery. J Urol. Sep 2002;168(3):1096-7. [Medline].

  113. Hatzichristou DG, Apostolidis A, Tzortzis V, Hatzimouratidis K, Ioannides E, Yannakoyorgos K. Glansectomy: an alternative surgical treatment for Buschke-Löwenstein tumors of the penis. Urology. May 2001;57(5):966-9. [Medline].

  114. Davis JW, Schellhammer PF. Glansectomy: an alternative surgical treatment for Buschke-Lowenstein tumours of the penis. BJU Int. Oct 2001;88(6):647. [Medline].

  115. Korets R, Koppie TM, Snyder ME, Russo P. Partial penectomy for patients with squamous cell carcinoma of the penis: the Memorial Sloan-Kettering experience. Ann Surg Oncol. Dec 2007;14(12):3614-9. [Medline].

  116. Mazza ON, Cheliz GM. Glanuloplasty with scrotal flap for partial penectomy. J Urol. Sep 2001;166(3):887-9. [Medline].

  117. Smith Y, Hadway P, Biedrzycki O, Perry MJ, Corbishley C, Watkin NA. Reconstructive surgery for invasive squamous carcinoma of the glans penis. Eur Urol. Oct 2007;52(4):1179-85. [Medline].

  118. Gulino G, Sasso F, Falabella R, Bassi PF. Distal urethral reconstruction of the glans for penile carcinoma: results of a novel technique at 1-year of followup. J Urol. Sep 2007;178(3 Pt 1):941-4. [Medline].

  119. Pietrzak P, Corbishley C, Watkin N. Organ-sparing surgery for invasive penile cancer: early follow-up data. BJU Int. Dec 2004;94(9):1253-7. [Medline].

  120. da Fonseca AG, Rabelo GN, Vidal KS, de Sousa FJ. Glandectomy with preservation of corpora cavernosa in the treatment of penile carcinoma. Int Braz J Urol. Sep-Oct 2003;29(5):437-40. [Medline].

  121. Martins FE, Rodrigues RN, Lopes TM. Organ-preserving surgery for penile carcinoma. Adv Urol. 2008;634216. [Medline].

  122. Kayes OJ, Durrant CA, Ralph D, Floyd D, Withey S, Minhas S. Vertical rectus abdominis flap reconstruction in patients with advanced penile squamous cell carcinoma. BJU Int. Jan 2007;99(1):37-40. [Medline].

  123. Bevan-Thomas R, Slaton JW, Pettaway CA. Contemporary morbidity from lymphadenectomy for penile squamous cell carcinoma: the M.D. Anderson Cancer Center Experience. J Urol. Apr 2002;167(4):1638-42. [Medline].

  124. Lont AP, Kroon BK, Gallee MP, van Tinteren H, Moonen LM, Horenblas S. Pelvic lymph node dissection for penile carcinoma: extent of inguinal lymph node involvement as an indicator for pelvic lymph node involvement and survival. J Urol. Mar 2007;177(3):947-52; discussion 952. [Medline].

  125. Abi-Aad AS, deKernion JB. Controversies in ilioinguinal lymphadenectomy for cancer of the penis. Urol Clin North Am. May 1992;19(2):319-24. [Medline].

  126. Coblentz TR, Theodorescu D. Morbidity of modified prophylactic inguinal lymphadenectomy for squamous cell carcinoma of the penis. J Urol. Oct 2002;168(4 Pt 1):1386-9. [Medline].

  127. Szostak MJ, Jacobs SC, Sklar GN. Use of in situ spermatic cord patch for inguinal lymph node dissection. Tech Urol. Mar 2001;7(1):64-6. [Medline].

  128. McDougal WS, Kirchner FK Jr, Edwards RH, Killion LT. Treatment of carcinoma of the penis: the case for primary lymphadenectomy. J Urol. Jul 1986;136(1):38-41. [Medline].

  129. Kroon BK, Horenblas S, Meinhardt W, et al. Dynamic sentinel node biopsy in penile carcinoma: evaluation of 10 years experience. Eur Urol. May 2005;47(5):601-6; discussion 606. [Medline].

  130. Velazquez EF, Ayala G, Liu H, et al. Histologic grade and perineural invasion are more important than tumor thickness as predictor of nodal metastasis in penile squamous cell carcinoma invading 5 to 10 mm. Am J Surg Pathol. Jul 2008;32(7):974-9. [Medline].

  131. Ficarra V, Zattoni F, Artibani W, et al. Nomogram predictive of pathological inguinal lymph node involvement in patients with squamous cell carcinoma of the penis. J Urol. May 2006;175(5):1700-4; discussion 1704-5. [Medline].

  132. Ficarra V, Zattoni F, Cunico SC, et al. Lymphatic and vascular embolizations are independent predictive variables of inguinal lymph node involvement in patients with squamous cell carcinoma of the penis: Gruppo Uro-Oncologico del Nord Est (Northeast Uro-Oncological Group) Penile Cancer data base data. Cancer. Jun 15 2005;103(12):2507-16. [Medline].

  133. Guimaraes GC, Lopes A, Campos RS, et al. Front pattern of invasion in squamous cell carcinoma of the penis: new prognostic factor for predicting risk of lymph node metastases. Urology. Jul 2006;68(1):148-53. [Medline].

  134. Zhu Y, Zhou XY, Yao XD, Dai B, Ye DW. The prognostic significance of p53, Ki-67, epithelial cadherin and matrix metalloproteinase-9 in penile squamous cell carcinoma treated with surgery. BJU Int. Jul 2007;100(1):204-8. [Medline].

  135. Protzel C, Knoedel J, Zimmermann U, Woenckhaus C, Poetsch M, Giebel J. Expression of proliferation marker Ki67 correlates to occurrence of metastasis and prognosis, histological subtypes and HPV DNA detection in penile carcinomas. Histol Histopathol. Nov 2007;22(11):1197-204. [Medline].

  136. Guimaraes GC, Leal ML, Campos RS, et al. Do proliferating cell nuclear antigen and MIB-1/Ki-67 have prognostic value in penile squamous cell carcinoma?. Urology. Jul 2007;70(1):137-42. [Medline].

  137. Campos RS, Lopes A, Guimaraes GC, Carvalho AL, Soares FA. E-cadherin, MMP-2, and MMP-9 as prognostic markers in penile cancer: analysis of 125 patients. Urology. Apr 2006;67(4):797-802. [Medline].

  138. Tobias-Machado M, Tavares A, Ornellas AA, Molina WR Jr, Juliano RV, Wroclawski ER. Video endoscopic inguinal lymphadenectomy: a new minimally invasive procedure for radical management of inguinal nodes in patients with penile squamous cell carcinoma. J Urol. Mar 2007;177(3):953-7; discussion 958. [Medline].

  139. Sotelo R, Sanchez-Salas R, Carmona O, et al. Endoscopic lymphadenectomy for penile carcinoma. J Endourol. Apr 2007;21(4):364-7; discussion 367. [Medline].

  140. Josephson DY, Jacobsohn KM, Link BA, Wilson TG. Robotic-assisted endoscopic inguinal lymphadenectomy. Urology. Jan 2009;73(1):167-70; discussion 170-1. [Medline].

  141. Izawa J, Kedar D, Wong F, Pettaway CA. Sentinel lymph node biopsy in penile cancer: evolution and insights. Can J Urol. Feb 2005;12 Suppl 1:24-9. [Medline].

  142. Perdona S, Autorino R, De Sio M, et al. Dynamic sentinel node biopsy in clinically node-negative penile cancer versus radical inguinal lymphadenectomy: a comparative study. Urology. Dec 2005;66(6):1282-6. [Medline].

  143. Kroon BK, Nieweg OE, van Boven H, Horenblas S. Size of metastasis in the sentinel node predicts additional nodal involvement in penile carcinoma. J Urol. Jul 2006;176(1):105-8. [Medline].

  144. Gonzaga-Silva LF, Tavares JM, Freitas FC, Tomas Filho ME, Oliveira VP, Lima MV. The isolated gamma probe technique for sentinel node penile carcinoma detection is unreliable. Int Braz J Urol. Jan-Feb 2007;33(1):58-63; discussion 64-7. [Medline].

  145. Kroon BK, Horenblas S, Estourgie SH, Lont AP, Valdes Olmos RA, Nieweg OE. How to avoid false-negative dynamic sentinel node procedures in penile carcinoma. J Urol. Jun 2004;171(6 Pt 1):2191-4. [Medline].

  146. Biedrzycki OJ, Hadway P, Cooke A, Watkin N, Corbishley C. Immunohistochemical analysis of negative inguinal lymph nodes in men with squamous cell carcinoma of the penis: are we missing micrometastases which could predict recurrence?. BJU Int. Jul 2006;98(1):70-3. [Medline].

  147. Saisorn I, Lawrentschuk N, Leewansangtong S, Bolton DM. Fine-needle aspiration cytology predicts inguinal lymph node metastasis without antibiotic pretreatment in penile carcinoma. BJU Int. Jun 2006;97(6):1225-8. [Medline].

  148. Tabatabaei S, Harisinghani M, McDougal WS. Regional lymph node staging using lymphotropic nanoparticle enhanced magnetic resonance imaging with ferumoxtran-10 in patients with penile cancer. J Urol. Sep 2005;174(3):923-7; discussion 927. [Medline].

  149. Spiess PE, Izawa JI, Bassett R, et al. Preoperative lymphoscintigraphy and dynamic sentinel node biopsy for staging penile cancer: results with pathological correlation. J Urol. Jun 2007;177(6):2157-61. [Medline].

  150. Heyns CF, Theron PD. Evaluation of dynamic sentinel lymph node biopsy in patients with squamous cell carcinoma of the penis and palpable inguinal nodes. BJU Int. Aug 2008;102(3):305-9. [Medline].

  151. Lerner SE, Jones JG, Fleischmann J. Management of recurrent penile cancer following partial or total penectomy. Urol Clin North Am. Nov 1994;21(4):729-37. [Medline].

  152. Montie JE. Follow-up after penectomy for penile cancer. Urol Clin North Am. Nov 1994;21(4):725-7. [Medline].

  153. Van Doornum GJ, Korse CM, Buning-Kager JC, et al. Reactivity to human papillomavirus type 16 L1 virus-like particles in sera from patients with genital cancer and patients with carcinomas at five different extragenital sites. Br J Cancer. Apr 7 2003;88(7):1095-100. [Medline].

  154. Lont AP, Kroon BK, Horenblas S, et al. Presence of high-risk human papillomavirus DNA in penile carcinoma predicts favorable outcome in survival. Int J Cancer. Sep 1 2006;119(5):1078-81. [Medline].

  155. Martins AC, Faria SM, Cologna AJ, Suaid HJ, Tucci S Jr. Immunoexpression of p53 protein and proliferating cell nuclear antigen in penile carcinoma. J Urol. Jan 2002;167(1):89-92; discussion 92-3. [Medline].

  156. Lopes A, Bezerra AL, Pinto CA, Serrano SV, de MellO CA, Villa LL. p53 as a new prognostic factor for lymph node metastasis in penile carcinoma: analysis of 82 patients treated with amputation and bilateral lymphadenectomy. J Urol. Jul 2002;168(1):81-6. [Medline].

  157. Alves G, Heller A, Fiedler W, et al. Genetic imbalances in 26 cases of penile squamous cell carcinoma. Genes Chromosomes Cancer. May 2001;31(1):48-53. [Medline].

  158. Garcia Rodriguez J, Fernandez Gomez JM, Rodriguez Martinez JJ, et al. [Clinical course of epidermoid carcinoma of the penis in our series]. Arch Esp Urol. Jan-Feb 2003;56(1):30-6. [Medline].

  159. Ornellas AA, Nobrega BL, Wei Kin Chin E, Wisnescky A, da Silva PC, de Santos Schwindt AB. Prognostic factors in invasive squamous cell carcinoma of the penis: analysis of 196 patients treated at the Brazilian National Cancer Institute. J Urol. Oct 2008;180(4):1354-9. [Medline].

  160. Cubilla AL. The role of pathologic prognostic factors in squamous cell carcinoma of the penis. World J Urol. Sep 3 2008;[Medline].

  161. Emerson RE, Ulbright TM, Eble JN, Geary WA, Eckert GJ, Cheng L. Predicting cancer progression in patients with penile squamous cell carcinoma: the importance of depth of invasion and vascular invasion. Mod Pathol. Oct 2001;14(10):963-8. [Medline].

  162. Kattan MW, Ficarra V, Artibani W, et al. Nomogram predictive of cancer specific survival in patients undergoing partial or total amputation for squamous cell carcinoma of the penis. J Urol. Jun 2006;175(6):2103-8; discussion 2108. [Medline].

  163. Ornellas AA, Kinchin EW, Nobrega BL, Wisnescky A, Koifman N, Quirino R. Surgical treatment of invasive squamous cell carcinoma of the penis: Brazilian National Cancer Institute long-term experience. J Surg Oncol. May 1 2008;97(6):487-95. [Medline].

  164. Leewansangtong S, Srinualnad S, Chaiyaprasithi B, Taweemonkongsap T, Soontrapa S. The risks of lymph node metastasis and the prognostic factors in carcinoma of the penis: analysis of 50 patients treated with bilateral ilioinguinal lymphadenectomy. J Med Assoc Thai. Feb 2001;84(2):204-11. [Medline].

  165. Horenblas S, van Tinteren H. Squamous cell carcinoma of the penis. IV. Prognostic factors of survival: analysis of tumor, nodes and metastasis classification system. J Urol. May 1994;151(5):1239-43. [Medline].

  166. Pandey D, Mahajan V, Kannan RR. Prognostic factors in node-positive carcinoma of the penis. J Surg Oncol. Feb 1 2006;93(2):133-8. [Medline].

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Further Reading

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Keywords

penile squamous cell carcinoma, penile SCC, SCC, penile cancer, genital cancer, penile tumor, epidermoid carcinoma of the penis, verrucous carcinoma, Buschke-Loewenstein tumor, penile malignant neoplasm, Bowen's disease, Bowen disease, erythroplasia of Queyrat, bowenoid papulosis, leukoplakia, HPV infection, human papillomavirus infection, penile lichen sclerosus, balanitis, PKMB

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Contributor Information and Disclosures

Author

Giuseppe Micali, MD, Head, Professor, Department of Dermatology, University of Catania School of Medicine, Italy
Giuseppe Micali, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Maria R Nasca, MD, PhD, Assistant Professor, Department of Dermatology, University of Catania School of Medicine, Italy
Disclosure: Nothing to disclose.

Medical Editor

Alexa F Boer Kimball, MD, MPH, Associate Professor of Dermatology, Harvard University School of Medicine; Vice Chair, Department of Dermatology, Massachusetts General Hospital; Director of Clinical Unit for Research Trials in Skin (CURTIS), Department of Dermatology, Massachusetts General Hospital and Brigham and Women's Hospital
Alexa F Boer Kimball, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Van Perry, MD, Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas Health Science Center
Van Perry, MD is a member of the following medical societies: American Academy of Dermatology and American Society for Laser Medicine and Surgery
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: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

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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