Pseudoepitheliomatous, keratotic, and micaceous balanitis is an uncommon precancerous condition of the glans penis in an older male. Untreated, some go on to verrucous or squamous cell carcinoma (SCC).
A chronic, red, scaly, keratotic change of the glans penis is seen. The scale is usually micaceous and resembles psoriasis. Thick, keratotic plaques may occur, deviating the urinary stream. Cutaneous horns or lesions resembling a nail may be seen. Pain, phimosis, and interference with sexual activity may be reasons patients seek medical attention. Most patients are over the age of 50 and usually are either uncircumcised or were circumcised in adult life.
Biopsy is indicated to establish the diagnosis, document any atypia, and rule out frank malignancy. Topical 5-FU has been used with success as has photodynamic therapy. Topical imiquimod is another potential approach. Surgery has also been performed especially when there is cellular atypia histologically. Since recurrences are common and SCC may develop, followup surveillance is indicated.
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