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| __NOTOC__
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| {{CMG}}{{AE}}{{VD}}
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| {{SK}}Bowen's disease, Bowenoid papulosis, Erythroplasia of Queyrat
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| ==Overview==
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| Balanitis is inflammation of glans penis, whenever balanitis involves foreskin and perpuce, it is termed as balanoposthitis. Bowenoid papulosis, Erythroplasia of Queyrat, and Bowen disease are the penile carcinoma in situ causing balanitis. The exact pathogenesis for these conditions is not clearly known, but there is a strong association between Human papilloma virus and penile carcinoma in situ. Patients may be asymptomatic or present with pruritic, or painful lesions in the genital region. Diagnosis is based on the clinical features supported by biopsy. Transformation of invasive squamous cell carcinoma is the major complication of these conditions. Treatment for these conditions include medical and surgical modalities.
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| ==Historical Perspective==
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| '''Bowenoid papulosis'''
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| In 1977, term Bowenoid papulosis was coined by Kopf and Bart and named after dermatologist John templeton Bowen
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| '''Erythroplasia of Queyrat'''
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| * In 1891, Tarnovsky for the first time described Erythroplasia of Queyrat.
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| * In 1893, Fournier and Darier appreciated it as a penile disease.
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| * in 1933, Sulzberger recognized it as carcinoma in situ.
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| '''Bowen disease'''
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| In 1912, Bowen's Disease was described by the American dermatologist John T. Bowen
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| ==Classification==
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| There is no established classification for Balanitits caused by Penile carcinoma in situ
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| ==Pathophysiology==
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| ==='''Bowenoid papulosis'''===
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| The exact pathogenesis of Bowenoid papulosis is unknown.
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| Some studies have shown, HPV type 16, 31, and 39 to play an etiological role in Bowenoid papulosis.
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| =====Associated conditions include: =====
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| *HIV
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| *Lymphopenia
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| *Depressed cell-mediated immunity
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| =====Histopathology=====
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| *The histopathology may reveal squamous cell carcinoma in situ, with widened spinous epidermal layer with proliferation of atypical basal cells, coilocytes, enlarged polimorfic and hyperchromatic nuclei as well as abnormal mitosis and hyperparakeratosis with collection of melanin of various amount seen.
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| [[File:Bowenoid papulosis histopathology.png|center|thumb|666x666px|Bowenoid papulosis histopathology|link=http://www.wikidoc.org/index.php/File:Bowenoid_papulosis_histopathology.png]]
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|
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| ===Erythroplasia of Queyrat===
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| The exact pathogenesis of erythroplasia of Queyrat is unknown.
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| Some studies have shown, chronic irritation, Inflammation, phimosis, smoking, smegma, poor hygiene, genital herpes simplex, HPV, heat, friction, maceration, trauma, perpuce dermatoses, such Lichen sclerosis or Lichen planus, may act as a risk factors for developing Erythroplasia of Queyrat.<ref name="pmid23806153">{{cite journal| author=Kutlubay Z, Engin B, Zara T, Tüzün Y| title=Anogenital malignancies and premalignancies: facts and controversies. | journal=Clin Dermatol | year= 2013 | volume= 31 | issue= 4 | pages= 362-73 | pmid=23806153 | doi=10.1016/j.clindermatol.2013.01.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23806153 }} </ref>
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| =====Associated conditions=====
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| *Epidermodysplasia verruciformis associated HPV-8
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| *Genital high-risk HPV-16
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| =====Histopathology=====
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| *Slight to moderate plaque-like acanthotic epidermis with focal parakeratosis and hypogranulosis with loss of epidermal cell polarity as evidenced by vacuolated cells, atypical mitoses, atypical epithelial cells with hyperchromatic nuclei, multinucleated cells, dyskeratotic cells, and mitotic figures in the upper Malpighian layers.
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| *The upper dermis is often edematous and densely invaded by a band-like plasma cell rich chronic round cell infiltrate.<ref name="pmid23806153">{{cite journal| author=Kutlubay Z, Engin B, Zara T, Tüzün Y| title=Anogenital malignancies and premalignancies: facts and controversies. | journal=Clin Dermatol | year= 2013 | volume= 31 | issue= 4 | pages= 362-73 | pmid=23806153 | doi=10.1016/j.clindermatol.2013.01.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23806153 }} </ref>
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| ===Bowen's Disease===
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| The exact pathogenesis of Bowen's disease is unknown.
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|
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| Some studies have shown, lack of circumcision, HPV infection, phimosis, balanitis, or any chronic inflammation of the penile skin act as a risk factor in developing Bowen's disease.<ref name="pmid14616349">{{cite journal| author=Arlette JP| title=Treatment of Bowen's disease and erythroplasia of Queyrat. | journal=Br J Dermatol | year= 2003 | volume= 149 Suppl 66 | issue= | pages= 43-9 | pmid=14616349 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14616349 }} </ref>
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| =====Associated conditions=====
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| *HPV types 16<ref name="pmid21272092">{{cite journal| author=Henquet CJ| title=Anogenital malignancies and pre-malignancies. | journal=J Eur Acad Dermatol Venereol | year= 2011 | volume= 25 | issue= 8 | pages= 885-95 | pmid=21272092 | doi=10.1111/j.1468-3083.2010.03969.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21272092 }} </ref>
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| *HPV type 33
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| =====Histopathology=====
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| Full-thickness epidermal atypia with disordered architecture, abnormal mitoses, dyskeratosis, and involvement of associated pilosebaceous apparatus with an intact epidermal junction.<ref name="pmid14616349">{{cite journal| author=Arlette JP| title=Treatment of Bowen's disease and erythroplasia of Queyrat. | journal=Br J Dermatol | year= 2003 | volume= 149 Suppl 66 | issue= | pages= 43-9 | pmid=14616349 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14616349 }} </ref>[[File:Bowen's disease histopathology.png|center|frameless|716x716px|Bowen's disease <ref name="pmid14616349">{{cite journal| author=Arlette JP| title=Treatment of Bowen's disease and erythroplasia of Queyrat. | journal=Br J Dermatol | year= 2003 | volume= 149 Suppl 66 | issue= | pages= 43-9 | pmid=14616349 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14616349 }} </ref>histopathology|link=http://www.wikidoc.org/index.php/File:Bowen's_disease_histopathology.png]]
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| ==Epidemiology and Demographics==
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| There are no comprehensive studies reporting the incidence and prevalence of penile carcinoma in situ in general population. Some studies have reported the demographics of patients presenting with these diagnosis.
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| ===='''Bowenoid papulosis'''====
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| Bowenoid papulosis usually occurs in sexually active men aged between 20 to 40 years, with a mean age of 31 years, it occurs slightly more common in women then men.<ref name="pmid23806153">{{cite journal| author=Kutlubay Z, Engin B, Zara T, Tüzün Y| title=Anogenital malignancies and premalignancies: facts and controversies. | journal=Clin Dermatol | year= 2013 | volume= 31 | issue= 4 | pages= 362-73 | pmid=23806153 | doi=10.1016/j.clindermatol.2013.01.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23806153 }} </ref>
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|
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| ====Erythroplasia of Queyrat====
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| Erythroplasia of Queyrat is a rare condition usually affecting uncircumcised men in their third to sixth decades of life.<ref name="pmid23806153">{{cite journal| author=Kutlubay Z, Engin B, Zara T, Tüzün Y| title=Anogenital malignancies and premalignancies: facts and controversies. | journal=Clin Dermatol | year= 2013 | volume= 31 | issue= 4 | pages= 362-73 | pmid=23806153 | doi=10.1016/j.clindermatol.2013.01.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23806153 }} </ref>
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|
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| ====Bowen's Disease====
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| Bowen's disease is occurs equally in both men and women, with the highest incidence inpatients older than age 60 years.<ref name="pmid23806153">{{cite journal| author=Kutlubay Z, Engin B, Zara T, Tüzün Y| title=Anogenital malignancies and premalignancies: facts and controversies. | journal=Clin Dermatol | year= 2013 | volume= 31 | issue= 4 | pages= 362-73 | pmid=23806153 | doi=10.1016/j.clindermatol.2013.01.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23806153 }} </ref>
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| ==Screening==
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| There are no established screening guidelines to screen patients for penile carcinoma in situ.
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| ==Natural History, Complications, and Prognosis==
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| ===Natural history===
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| '''Bowenoid papulosis'''
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|
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| If left untreated, papules may increase, decrease, or the lesions may disappear with time, or progress into squamous cell carcinoma(Studies have reported risk of progression of Bowenoid papulosis to Squamous cell carcinoma at 2.6%).<ref name="pmid23806153">{{cite journal| author=Kutlubay Z, Engin B, Zara T, Tüzün Y| title=Anogenital malignancies and premalignancies: facts and controversies. | journal=Clin Dermatol | year= 2013 | volume= 31 | issue= 4 | pages= 362-73 | pmid=23806153 | doi=10.1016/j.clindermatol.2013.01.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23806153 }} </ref>
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| ====Erythroplasia of Queyrat====
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| If left untreated, Erythroplasia of Queyrat may progress into invasive Squamous cell carcinoma, with an incidence ranging from 10% to 33%.<ref name="pmid23806153">{{cite journal| author=Kutlubay Z, Engin B, Zara T, Tüzün Y| title=Anogenital malignancies and premalignancies: facts and controversies. | journal=Clin Dermatol | year= 2013 | volume= 31 | issue= 4 | pages= 362-73 | pmid=23806153 | doi=10.1016/j.clindermatol.2013.01.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23806153 }} </ref>
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| ====Bowen's Disease====
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| If left untreated, Bowen's disease may progress into invasive Squamous cell carcinoma(Incidence of Bowen's disease to develop into invasive squamous cell carcinoma is 3% to 5% for cutaneous and 10% for genital lesions). The malignant potential of Bowen's disease is increased when its existence is compounded by concomitant disease such as HPV infection, LS or LP, or in patients with poor genital hygiene and smokers.<ref name="pmid23806153">{{cite journal| author=Kutlubay Z, Engin B, Zara T, Tüzün Y| title=Anogenital malignancies and premalignancies: facts and controversies. | journal=Clin Dermatol | year= 2013 | volume= 31 | issue= 4 | pages= 362-73 | pmid=23806153 | doi=10.1016/j.clindermatol.2013.01.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23806153 }} </ref>
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| ===Complications===
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| Complication of penile carcinoma in situ include:<ref name="pmid23806153">{{cite journal| author=Kutlubay Z, Engin B, Zara T, Tüzün Y| title=Anogenital malignancies and premalignancies: facts and controversies. | journal=Clin Dermatol | year= 2013 | volume= 31 | issue= 4 | pages= 362-73 | pmid=23806153 | doi=10.1016/j.clindermatol.2013.01.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23806153 }} </ref>
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| * Pain
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| * Transformation of invasive squamous cell carcinoma
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| ===Prognosis===
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| The prognosis is usually good with treatment.
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|
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| ==Diagnosis==
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| ===History and symptoms===
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|
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| History and symptoms of penile carcinoma in situ include:<ref name="pmid23806153">{{cite journal| author=Kutlubay Z, Engin B, Zara T, Tüzün Y| title=Anogenital malignancies and premalignancies: facts and controversies. | journal=Clin Dermatol | year= 2013 | volume= 31 | issue= 4 | pages= 362-73 | pmid=23806153 | doi=10.1016/j.clindermatol.2013.01.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23806153 }} </ref>
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| '''Bowenoid papulosis'''
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|
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| Patients may be asymptomatic or present with pruritic, or painful lesions in the genital region.
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| ====Erythroplasia of Queyrat====
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| Patients may present with non-healing lesions in the genital region, which could also be associated with scaling, crusting, and bleeding.
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|
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| ==== Bowen's Disease ====
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| Patient may be asymptomatic or present with pruritic, or painful lesions in the genital region.
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|
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| ===Physical examination===
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| Physical examination findings of penile carcinoma in situ include:<ref name="pmid23806153">{{cite journal| author=Kutlubay Z, Engin B, Zara T, Tüzün Y| title=Anogenital malignancies and premalignancies: facts and controversies. | journal=Clin Dermatol | year= 2013 | volume= 31 | issue= 4 | pages= 362-73 | pmid=23806153 | doi=10.1016/j.clindermatol.2013.01.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23806153 }} </ref>
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| {| class="wikitable"
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| ! colspan="3" |Physical examination findings of penile carcinoma in situ
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| |-
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| |'''Bowenoid papulosis'''
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| |'''Erythroplasia of Queyrat'''
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| |'''Bowen's Disease'''
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| |-
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| |Multiple, small, well-demarcated, grey-brown, red, pink, or skin-colored papillomatous papules or small patches on the penile shaft, glans, or foreskin, vulva, and perianal area .The papules are nonpruritic, range in size from 2 to 10 mm, and usually lack scale.
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| * Single or multiple red, shiny, slightly raised, sharply demarcated, velvety, non-healing plaques associated with scaling, crusting, and sometimes bleeding, affecting the mucosal surfaces of the penis.
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| * Inguinal nodes should be examined(Several studies have reported, Erythroplasia of Queyrat have tendency to metastasis to local lymph nodes)
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|
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| |Red, sometimes slightly pigmented, scaly, moist, velvety patches and plaques of the keratinized penis.
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| |}
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| [[File:Bowen disease .png|frameless|500x500px|Bowen's Disease|link=http://www.wikidoc.org/index.php/File:Bowen_disease_.png|center]]
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| [[File:Bowenoid papulosis.png|frameless|500x500px|link=http://www.wikidoc.org/index.php/File:Bowenoid_papulosis.png|center]]
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|
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| === Laboratory findings ===
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| Definite diagnosis is made by a biopsy showing the typical histologic picture of intraepidermal carcinoma ''in situ''.
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| ==Treatment==
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| Choice of treatment in penile carcinoma in situ depends after careful analysis of lesion size, number, site, degree of functional impairment, modality availability and cost.
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| Modalities for treating penile carcinoma in situ include:<ref name="pmid23806153">{{cite journal| author=Kutlubay Z, Engin B, Zara T, Tüzün Y| title=Anogenital malignancies and premalignancies: facts and controversies. | journal=Clin Dermatol | year= 2013 | volume= 31 | issue= 4 | pages= 362-73 | pmid=23806153 | doi=10.1016/j.clindermatol.2013.01.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23806153 }} </ref>
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| '''Bowenoid papulosis'''
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|
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| ===== Conservative treatment =====
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| * Topical 5-FU, podophylin, retinoic acid, and cidofovir; only moderate effects have been reported.
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| * Imiquimod cream 5% reported successful clearance of bowenoid papulosis.
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|
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| ===== Surgical treatment =====
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| Surgical modalities in treating Bowenoid papulosis include:
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| Cryosurgery, electrodessication, laser vaporization (Nd:YAG, argon, and carbon dioxide lasers), and surgical excision. All these modalities are found to associated with scarring.
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| ==== Erythroplasia of Queyrat ====
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| '''Conservative treatment'''
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| Imiquimod and Topical 5-FU application, the help in minimizing the risk for scarring, poor wound healing, and functional impairment.
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| '''Surgical treatment'''
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| Surgical modalities in treating Erythroplasia of Queyrat include: Mohs micrographic surgery, cryotherapy, electrodesiccation and curettage, and laser ablation.
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| ==== Bowen's Disease ====
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| '''Conservative treatment'''
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| * Photodynamic therapy and Topical 5-FU application, the help in minimizing the risk for scarring, poor wound healing, and functional impairment.
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| * Recent studies have found that topical application of Imiquimod cream 5% once daily for 16 weeks was effective in treating Bowen's disease.
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| '''Surgical treatment'''
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| Surgical modalities in treating Bowen's disease include: Local excision, Mohs micrographic surgery, cryotherapy, curettage with cautery⁄electrocautery, laser therapy with carbon dioxide, argon, and Nd:YAG lasers.
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| == Prevention ==
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| ===Primary Prevention===
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| There are no primary preventive measures available for penile carcinoma in situ.
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| ===Secondary prevention===
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| There are no Secondary preventive measures available for penile carcinoma in situ
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| ==References==
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