By Gary M. White, MD
Erythroplasia of Queyrat is a term used to describe squamous cell carcinoma in situ of the penis. Several risk factors have been noted including lack of circumcision in infancy or early childhood, HPV infection, balanitis, and smoking. Other factors may be related including the chronic presence of smegma (which may be converted to carcinogenic agents by Mycobacterium smegmatis), phimosis, PUVA therapy, and the presence of lichen sclerosus.
A fixed red area on the glans that slowly expands over time is characteristic. Usually, the patient is an elderly, uncircumcised man. This disease represents a squamous cell carcinoma in situ, although a frankly invasive squamous cell carcinoma may be found. The urethral area should be evaluated if the lesion involves that area.
Surgical excision is the treatment of choice. Mohs surgery may help conserve tissue. Imiquimod has been gaining acceptance. A typical regimen is application QOD for 12 weeks. Alternatives include laser ablation with the CO2 or the Nd:YAG with or without acetic acid presoak or topical application of 5-FU.
See also Penile Intraepithelial Neoplasia
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