Pseudoepitheliomatous keratotic and micaceous balanitis

Signs and symptoms

PKMB manifests as a densely adherent micaceous scaling on top of a thick hyperkeratotic plaque. While there may be occasional signs of irritation, burning sensation, fissuring, or maceration, PKMB is usually asymptomatic. There are situations where the thickness of the plaque is so thick that it gives the appearance of a penile horn. When micturition occurs, hyperkeratotic plaques involving the perimeatal skin may result in several urine streams, producing the appearance of a "watering-can penis."

Causes

It is unknown exactly what causes PKMB. It's thought to be a pseudoepitheliomatous reaction to infection or a type of pyodermatitis.

Mechanism

There are four stages in the pathogenesis of PKMB: the early plaque stage, the late tumor stage, verrucous carcinoma, and the transformation to squamous cell carcinoma and invasion.

Diagnosis

The histological examination reveals a non-specific dermal inflammatory infiltration consisting of lymphocytes and eosinophils, together with hyperkeratosis, parakeratosis, acanthosis, elongated rete ridges, and mild lower epidermal dysplasia.

Differential diagnosis of PKMB includes other diseases on male genitalia-like giant condyloma, squamous cell carcinoma, psoriasis, and erythroplasia of Queyrat.

Treatment

The course of treatment depends on the stage of the lesion; topical therapy is necessary for the early plaque stage, while more aggressive therapy is required for the advanced stages. When there is no histological indication of cancer, cryotherapy and topical 5-flourouracil are the recommended courses of treatment. When there are atypia-related features, extensive surgical excision is necessary to achieve both satisfactory cosmetic and functional outcomes.

Outlook

PKMB was once thought to be a completely benign illness, but new research has revealed that it is actually a unique entity that spans a histologic spectrum from verrucous carcinoma to hypertrophic-hyperplastic penile dystrophy. The lesion should be regarded as having low-grade or limited malignant potential, as it may exhibit aggressive or locally invasive tendencies.

References

References

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11. (1988). "Pseudoepitheliomatous, keratotic, micaceous balanitis. A clinical lesion with two histologic subsets: hyperplastic dystrophy and verrucous carcinoma". Journal of the American Academy of Dermatology.
12. (1981). "Pseudoepitheliomatous, keratotic, and micaceous balanitis". Archives of Dermatology.