Bowen's disease of the penis
Dr James Baber looks at the diagnosis and care of a penile lesion.A 61-year-old man presents with a three-month history of a well-defined erythematous, red scaly plaque on the shaft of the penis.
The lesion is not itchy or painful, there are no other genital lesions, and there has been no response to Hydrozole cream.
Examination of other skin areas shows no other plaques, and the nails are normal.
Bowen’s disease of the penis
This is one of the clinical terms used to describe squamous cell carcinoma (SCC) in situ.
On the penis it may be known as Erythroplasia of Queyrat.
Bowen’s disease appears as discrete red, or sometimes pigmented, scaly plaques on the shaft of the penis. Bowen’s disease is found on the glans penis, or prepuce, of uncircumcised men and appears as well demarcated, glistening red, solitary or multiple lesions.
|Bowen's disease key facts|
As there are no associated symptoms of discomfort or irritation, the plaques are often present for several months or even years before presentation.
Bowen’s disease of the penis can develop into locally invasive disease, with the potential for metastasis.
- Nummular eczema
- Balanitis circinata (Reiter’s syndrome)
- Lichen planus
- Candidal balanitis
- Zoon’s balanitis
- Invasive SCC
- Fixed drug eruption.
A skin biopsy of the penis can usually be performed easily.
A skin shave can be obtained by raising a small ellipse of skin with fine forceps, and using a scalpel blade to excise the sample. Bleeding can be controlled with the application of silver nitrate.
Another option is to use a 3-4 mm punch biopsy blade, which provides a tubular sample of the dermal and epidermal layers that can be removed from the basal subcutaneous tissue with scissors.
The punch biopsy site, which heals rapidly, can be sutured with 4.0 VICRYL or held together with steristrips.
Excision of the lesion with 5 mm margins has the lowest recurrence rate (about 5% to 15%), and is the treatment of choice on the penis.
Mohs micrographic surgery may be used to ensure tissue sparing with larger lesions. Alternatively, cryotherapy with a single freeze thaw cycle of 30 seconds has been used with good success (less than 10% recurrence at 12 months).
Another option that can be useful for difficult penile lesions, is CO2 laser ablation. Topical 5% 5-fluorouracil has been used in several studies, but its use as a curative treatment is limited by local irritant side-effects.
More recently, successful use of topical 5% imiquimod has been described, applied five times per week for six weeks. Photodynamic therapy has been used for Bowen’s disease of the penis successfully with minimal scarring.
Due to the high rate of metastases if invasive SCC develops, it is important to follow up the patient regularly for several years to monitor for recurrence or metastatic disease.
Dr James Baber is a sexual health registrar at Royal North Shore Hospital, Sydney.
Tags: , Skin Things