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Iafrate M, Mancini M, Prayer Galetti T, Szekely S, Zattra E, Vaccari D, Piaserico S. Efficacy of topical photodynamic therapy in the treatment of Erythroplasia of Queyrat. Dermatol Reports 2020; 12:8566. [PMID: 32655845 PMCID: PMC7336270 DOI: 10.4081/dr.2020.8566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/24/2020] [Indexed: 11/22/2022] Open
Abstract
Erythroplasia of Queyrat (EQ) is an intraepidermal carcinoma in situ presenting clinically as a sharply demarcated, slightly raised erythematosus plaque on the glans penis or the inner side of the foreskin. Various treatment modalities for EQ have been proposed, including electrocautery and curettage, topical 5-floururacil cream, imiquimod cream, isotretinoin, cryotherapy, laser therapy, radiotherapy, ingenol mebutate gel and Photodynamic Therapy (PDT). Most of these treatments are limited by low clearance rates and frequent relapses. Surgical treatment including local excision, Mohs micrographic surgery and partial or total penectomy, ensures adequate healing rates. However, discomfort consequent to surgical treatment might be unacceptable. Topical PDT using the methyl ester of 5- aminolaevulinic acid (MAL) is an established non-surgical treatment of cutaneous precancerous lesions and skin cancers. We present the case of a 60-year-old uncircumcised man affected by EQ of the penis successfully treated with MAL-PDT, performed five times, two weeks apart, with no recurrences after 6 years.
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Affiliation(s)
- Massimo Iafrate
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology - Urology Clinic, University of Padua
| | - Mariangela Mancini
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology - Urology Clinic, University of Padua
| | - Tommaso Prayer Galetti
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology - Urology Clinic, University of Padua
| | - Serena Szekely
- Unit of Dermatology, Department of Medicine, University of Padova, Padua, Italy
| | - Edoardo Zattra
- Unit of Dermatology, Department of Medicine, University of Padova, Padua, Italy
| | - Daniele Vaccari
- Unit of Dermatology, Department of Medicine, University of Padova, Padua, Italy
| | - Stefano Piaserico
- Unit of Dermatology, Department of Medicine, University of Padova, Padua, Italy
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Haney NM, Elegbede A, Wangsiricharoen S, Atallah C, Aliu O, Cohen AJ. Presentation of a Large and Debilitating Fungating Anogenital Lesion. Urology 2020; 143:e12-e16. [PMID: 32531464 DOI: 10.1016/j.urology.2020.05.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/11/2020] [Accepted: 05/25/2020] [Indexed: 11/28/2022]
Abstract
CASE REPORT A 65-year-old Caucasian man presented with a debilitating anogenital lesion. DIFFERENTIAL DIAGNOSIS The differential diagnosis of anogenital lesions includes infectious (syphilis, herpes simplex virus), noninfectious (hidradenitis suppuritiva, lymphedema), benign (condyloma acuminata), and malignant pathologies (squamous cell carcinoma, Kaposi sarcoma). DIAGNOSTIC ASSESSMENT, MANAGEMENT, AND OUTCOME Biopsy of an anogenital lesion will determine any oncologic potential. Further imaging can better characterize the disease. Once in the operating room, oncologic principles should be adhered to and quality of life concerns prioritized. Reconstruction of large defects may require a multidisciplinary team. Genitourinary and gastrointestinal diversions should be considered to improve wound healing, decrease infection risk, and optimize graft take. DISCUSSION A multidisciplinary approach to medical and surgical reconstruction of anogenital lesions should be considered for extensive malformations.
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Affiliation(s)
- Nora M Haney
- The Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD
| | - Adekunle Elegbede
- Department of Plastic Surgery, Johns Hopkins Hospital, Baltimore, MD
| | | | - Chady Atallah
- Department of Colorectal Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Oluseyi Aliu
- Department of Plastic Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Andrew J Cohen
- The Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD.
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Conforti C, Giuffrida R, Di Meo N, Longone M, Vichi S, Colli C, Deinlein T, Vezzoni R, Retrosi C, Errichetti E, Cannavò SP, Zalaudek I, Dianzani C. Benign dermatoses of the male genital areas: A review of the literature. Dermatol Ther 2020; 33:e13355. [PMID: 32239734 DOI: 10.1111/dth.13355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/26/2020] [Indexed: 11/26/2022]
Abstract
The male genitalia are a common site of dermatoses. Patients with penile diseases often delay or avoid medical care due to anxiety and embarrassment. In this narrative review, we describe some of the main benign dermatoses localized to male genital, focusing on their epidemiology, clinical and dermoscopic features, as well as available therapies.
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Affiliation(s)
- Claudio Conforti
- Dermatology Clinic, University of Trieste, Hospital Maggiore, Trieste, Italy
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | - Nicola Di Meo
- Dermatology Clinic, University of Trieste, Hospital Maggiore, Trieste, Italy
| | - Michela Longone
- Dermatology Clinic, University of Trieste, Hospital Maggiore, Trieste, Italy
| | - Silvia Vichi
- Dermatology Clinic, University of Trieste, Hospital Maggiore, Trieste, Italy
| | - Claudia Colli
- Dermatology Clinic, University of Trieste, Hospital Maggiore, Trieste, Italy
| | - Teresa Deinlein
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Roberta Vezzoni
- Dermatology Clinic, University of Trieste, Hospital Maggiore, Trieste, Italy
| | - Chiara Retrosi
- Dermatology Clinic, University of Trieste, Hospital Maggiore, Trieste, Italy
| | - Enzo Errichetti
- Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Udine, Italy
| | | | - Iris Zalaudek
- Dermatology Clinic, University of Trieste, Hospital Maggiore, Trieste, Italy
| | - Caterina Dianzani
- Department of Plastic Reconstructive and Cosmetic Surgery, Dermatology Section, Campus Bio-Medico University Hospital, Rome, Italy
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Meza-Romero R, Navarrete-Dechent C, Downey C. Molluscum contagiosum: an update and review of new perspectives in etiology, diagnosis, and treatment. Clin Cosmet Investig Dermatol 2019; 12:373-381. [PMID: 31239742 PMCID: PMC6553952 DOI: 10.2147/ccid.s187224] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 05/07/2019] [Indexed: 12/20/2022]
Abstract
Molluscum contagiosum (MC) is a self-limited infectious dermatosis, frequent in pediatric population, sexually active adults, and immunocompromised individuals. It is caused by molluscum contagiosum virus (MCV) which is a virus of the Poxviridae family. MCV is transmitted mainly by direct contact with infected skin, which can be sexual, non-sexual, or autoinoculation. Clinically, MC presents as firm rounded papules, pink or skin-colored, with a shiny and umbilicated surface. The duration of the lesions is variable, but in most cases, they are self-limited in a period of 6–9 months. The skin lesions may vary in size, shape, and location, which is more frequent in immunosuppressed patients, and could present complications such as eczema and bacterial superinfection. The diagnosis is based on clinical findings. A useful clinical tool is dermoscopy. If the diagnostic doubt persists, confocal microscopy or skin biopsy could be performed. The need for active treatment for MC is controversial; however, there is a consensus that it should be indicated in cases of extensive disease, associated with complications or aesthetic complaints. There are several treatment modalities which include mechanical, chemical, immunomodulatory, and antivirals. The objective of this article is to review the current evidence in etiology, clinical manifestations, diagnosis, and management alternatives of MC.
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Affiliation(s)
- Rodrigo Meza-Romero
- Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristián Navarrete-Dechent
- Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Camila Downey
- Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Lee TS, Kothari-Talwar S, Singhal PK, Yee K, Kulkarni A, Lara N, Roset M, Giuliano AR, Garland SM, Ju W. Cross-sectional study estimating the psychosocial impact of genital warts and other anogenital diseases in South Korea. BMJ Open 2019; 9:e025035. [PMID: 30898815 PMCID: PMC6475443 DOI: 10.1136/bmjopen-2018-025035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To estimate self-reported human papillomavirus (HPV) disease-related psychosocial impact among male and female patients in South Korea. DESIGN In this multicentre cross-sectional study, psychosocial impacts were estimated using a one-time survey capturing HPV Impact Profile (HIP) results, CuestionarioEspecifico en Condilomas Acuminados (CECA; in Spanish)-'Specific questionnaire for Condylomata Acuminata' and the EuroQol-5 Dimension (EQ-5D) surveys. Student's t-tests or Mann-Whitney U tests were used for continuous comparisons; χ2 or Fisher's exact tests were applied for categorical comparisons. SETTING 5098 clinics throughout Seoul, Busan, Daegu, Kwangju and Daejeon (South Korea). PARTICIPANTS Patients with and without genital warts (GW) (males) and selected HPV diseases (females) visiting primary care physicians, obstetricians/gynaecologists, urologists and dermatologists with 2-30 years experience. RESULTS Of 150 male and 250 female patients, HIP scores showed 85.3% of male patients with GW and 32.0% without reported moderate psychological impact (p<0.0001). In categorised total scores, 88.5% of female patients with and 66.0% without selected HPV-related diseases reported moderate or high psychological impacts (p=0.0004). In the CECA questionnaire, male patients had mean (SD) scores of 10.51 (3.79) in 'emotional health' and 15.90 (6.13) in 'sexual activity'. Female patients with GW reported lower scores in both dimensions with mean scores of 7.18 (4.17) in 'emotional health' and 10.97 (5.80) in 'sexual activity' (p<0.0001), indicating worse health-related quality of life (HRQoL). For the EQ-5D, male patients with GW reported lower mean Visual Analogue Scale (VAS) scores than those without (75.1 vs 81.13, p<0.0135). Mean VAS score and utility values were lower for females with HPV-related diseases than those without (72.18 vs 76.86 and 0.90 vs 0.94, respectively). CONCLUSION In South Korea, GW in men and HPV-related diseases in women negatively impact patient well-being and HRQoL scores. Among women, those with GW suffered a greater psychosocial impact than those with other selected HPV-related diseases.
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Affiliation(s)
- Taek Sang Lee
- Department of Obstetrics and Gynecology, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | | | | | - Karen Yee
- Cubist Pharmaceuticals Inc, Lexington, Massachusetts, USA
| | | | - Nuria Lara
- Real World Evidence Solutions, IQVIA, Barcelona, Spain
| | | | - Anna R Giuliano
- Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Suzanne M Garland
- Microbiology and Infectious Diseases Department, The Royal Women’s Hospital, Parkville, Victoria, Australia
| | - Woong Ju
- School of Medicine, Ewha Womans University, Seoul, South Korea
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Borghi A, Virgili A, Corazza M. Dermoscopy of Inflammatory Genital Diseases: Practical Insights. Dermatol Clin 2019; 36:451-461. [PMID: 30201154 DOI: 10.1016/j.det.2018.05.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Diagnosis of genital inflammatory disorders may be difficult for several reasons, such as their similar appearance, possible misdiagnosis with infectious and malignant conditions, and peculiar anatomic conditions that may lead to modification of clinical features. Dermoscopy could be included as a part of the clinical inspection of genital diseases to support diagnosis, as well as to ideally avoid unnecessary invasive investigation. Practical guidance for the use of dermoscopy in the assessment of the main inflammatory genital diseases is provided, namely for lichen sclerosus, lichen planus, psoriasis, lichen simplex chronicus, and plasma cell mucositis.
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Affiliation(s)
- Alessandro Borghi
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Via L. Ariosto 35, Ferrara 44121, Italy.
| | - Annarosa Virgili
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Via L. Ariosto 35, Ferrara 44121, Italy
| | - Monica Corazza
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Via L. Ariosto 35, Ferrara 44121, Italy
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Male Genital Dermatology: A Primer for the Sexual Medicine Physician. Sex Med Rev 2018; 7:71-83. [PMID: 30458984 DOI: 10.1016/j.sxmr.2018.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/04/2018] [Accepted: 09/15/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The dermatologic conditions affecting the male genitalia are diverse and range from normal variants and benign growths to overt malignancy. Unfortunately, there is a dearth of urologic dermatology training in most residency programs, and many dermatologic lesions with a classic appearance on other areas of the body may have atypical presentations on the genitalia. Patients may present to a variety of physicians without receiving a definitive diagnosis, which can be highly distressing to the afflicted individual. AIM To provide sexual medicine physicians tools to aid in the evaluation and diagnosis of urologic dermatology lesions, whether they are limited to the genitalia or part of a widespread systemic disease. METHODS Comprehensive review of the literature pertaining to genital dermatology in men. MAIN OUTCOME MEASURE We stratify each condition into 1 of 5 groups (normal variants and benign lesions, inflammatory lesions, transmissible lesions, premalignant lesions, and malignant lesions) and focus on presentation and prevalence of these conditions. RESULTS Sexual medicine physicians should emphasize the non-pathologic nature of normal variants of genital anatomy (ie, penile hyperpigmentation, pearly penile papules) and stress that removal of these lesions is only appropriate for cosmetic purposes. Benign genital growths (ie, sebaceous cysts, seborrheic keratoses) may not require intervention, but they should be monitored for atypical features and infection. In contrast, transmissible (ie, herpes, syphilis) and inflammatory (ie, psoriasis) lesions may necessitate prompt intervention to reduce transmission and complications of late-stage disease. Premalignant and malignant lesions may mimic many of the aforementioned conditions; it is important that patients receive routine follow-up after treatment. All suspicious non-healing or ulcerating lesions should undergo pathologic evaluation to rule out malignancy. CONCLUSION Urologic dermatology can be a diagnostic challenge for sexual medicine physicians. This review simplifies the diagnostic approach and emphasizes pathologic features of each condition to guide management. Gabrielson AT, Le TV, Fontenot C, et al. Male genital dermatology: A primer for the sexual medicine physician. Sex Med Rev 2019;7:71-83.
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