Erythroplasia of Queyrat: Difference between revisions

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{{CMG}} {{AE}} {{Ammu}}
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{{SK}} EQ
{{SK}} EQ
==Overview==
==Overview==
Erythroplasia of Queyrat was named after Louis Queyrat, a French dermatologist who was head of the dermatology service of l'Hôpital Ricord, a venereal hospital in Paris, now Hôpital Cochin. The pathogenesis of Erythroplasia of Queyrat is characterized as a precancerous lesion of [[squamous cell carcinoma]] in situ of the [[glans penis]] and inner [[prepuce]]. Erythroplasia of Queyrat is most commonly observed among white male patients aged 40 years old and older. The most common risk factor in the development of Erythroplasia of Queyrat is an uncircumcised penis. The mainstay of therapy for Erythroplasia of Queyrat is  imiquimod or 5-fluorouracil for several weeks to months.
Erythroplasia of Queyrat is a [[Penile carcinoma in situ|penile squamous cell carcinoma in situ]] named after Louis Queyrat, a French [[dermatologist]] who was head of the [[dermatology]] service of l'Hôpital Ricord, a [[venereal]] [[hospital]] in Paris, now Hôpital Cochin. The [[pathogenesis]] of erythroplasia of Queyrat is characterized as a [[precancerous]] lesion of [[squamous cell carcinoma]] in situ of the [[glans penis]] and inner [[prepuce]] or [[foreskin]]. Erythroplasia of Queyrat is most commonly observed among white [[male]] [[Patient|patients]] [[Age|aged]] 60 years old and older with [[Human Papillomavirus|Human papilloma virus]] ([[Human papillomavirus|HPV]]) infection or [[Chronic (medicine)|chronic]] [[irritation]] and lack of [[hygiene]] of [[pubic]] area. The most common [[risk factor]] in the [[development]] of erythroplasia of Queyrat is an [[Circumcised|uncircumcised]] [[penis]]. The mainstay of therapy for erythroplasia of Queyrat is  [[imiquimod]] or [[5-fluorouracil]] for several weeks to months.


==Historical Perspective==
==Historical Perspective==
*Erythroplasia of Queyrat was named after Louis Queyrat, a French dermatologist who was head of the dermatology service of l'Hôpital Ricord, a venereal hospital in Paris, now Hôpital Cochin.
*Erythroplasia of Queyrat was first discovered and named after Louis Queyrat.<ref>{{cite book | last = Weidner | first = Noel | title = Modern surgical pathology | publisher = Saunders/Elsevier | location = Philadelphia, PA | year = 2009 | isbn = 9781437719581 }}</ref>
Tarnovsky originally described erythroplasia of Queyrat in 1891, but it was Queyrat who coined the term erythroplasia in 1911.
*Louis Queyrat was French [[dermatologist]] who was head of the [[dermatology]] service of l'Hôpital Ricord, a [[venereal]] [[hospital]] in Paris, now Hôpital Cochin.
 
*Tarnovsky originally described erythroplasia of Queyrat in 1891, but it was Queyrat who originated the term erythroplasia in 1911.
[Disease name] was first discovered by [name of scientist], a [nationality + occupation], in [year]/during/following [event].
 
The association between [important risk factor/cause] and [disease name] was made in/during [year/event].
 
In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].
 
In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].
 
There have been several outbreaks of [disease name], including -----.
 
In [year], [diagnostic test/therapy] was developed by [scientist] to treat/diagnose [disease name].


==Classification==
==Classification==
Erythroplasia of Queyrat is classified as a precancerous lesion and the earliest stage of squamous cell cancer of the penis known as Carcinoma in Situ (CIS).  This is also known as stage 0 of penile cancer. In this stage, the cancer cells are found only in the top layers of skin. They have not yet grown into the deeper tissues.  
*Erythroplasia of Queyrat is classified as a [[precancerous]] lesion.
*The earliest stage of [[Squamous cell carcinoma|squamous cell cancer]] of the [[penis]] known as [[Carcinoma in situ|Carcinoma in situ]] [[Carcinoma in situ|(CIS)]].   
*This is also known as stage 0 of [[penile cancer]].  
*In this stage, the [[cancer]] [[Cells (biology)|cells]] are found only in the top layers of [[skin]]; they have not yet grown into the deeper [[Tissue (biology)|tissues]].<ref name="HakenbergCompérat2015">{{cite journal|last1=Hakenberg|first1=Oliver W.|last2=Compérat|first2=Eva M.|last3=Minhas|first3=Suks|last4=Necchi|first4=Andrea|last5=Protzel|first5=Chris|last6=Watkin|first6=Nick|title=EAU Guidelines on Penile Cancer: 2014 Update|journal=European Urology|volume=67|issue=1|year=2015|pages=142–150|issn=03022838|doi=10.1016/j.eururo.2014.10.017}}</ref>
*Depending on the location of the [[Carcinoma in situ|CIS]] on [[penis]], [[Doctor of Medicine|doctors]] may use other names for the [[disease]].
**[[Carcinoma in situ|CIS]] of the [[glans]] or [[prepuce]] is called erythroplasia of Queyrat, presents as [[erythroplakia]].
**[[Carcinoma in situ|CIS]] on the [[shaft]] of the [[penis]] (or other parts of the [[Genital area|genitals]]) is called [[Bowen's disease|Bowen disease]], presents as [[leukoplakia]].
*About 95% of [[Penile cancer|penile cancers]] start in flat [[skin]] [[Cell (biology)|cells]] called [[Squamous epithelium|squamous]] [[Cell (biology)|cells]].
*[[Squamous cell carcinoma]] can start anywhere on the [[penis]].
*Most of these [[Cancer|cancers]] start on the [[prepuce]] or [[foreskin]] (in men who have not been [[Circumcise|circumcised]]) or on the [[glans]].
*These [[Tumor|tumors]] tend to grow slowly. If they're found at an early stage, they can usually be [[Cure|cured]].


Depending on where the CIS is on the penis, doctors may use other names for the disease.
===Jackson's Staging System for Squamous Cell Carcinoma of Penis===
*CIS of the [[glans]] or [[prepuce]] is called Erythroplasia of Queyrat, presents as erythroplakia.
*[[Squamous cell carcinoma|Squamous cell carcinoma of penis]] may be classified according to [[Jackson's Staging System]] into number subtypes/groups:<ref>Lynch DF Jr. Cancer of the Penis. In: Kufe DW, Pollock RE, Weichselbaum RR, et al., editors. Holland-Frei Cancer Medicine. 6th edition. Hamilton (ON): BC Decker; 2003. Available from: https://www.ncbi.nlm.nih.gov/books/NBK13419/</ref>
*CIS on the shaft of the penis (or other parts of the genitals) is called [[Bowen disease]], presents as leukoplakia.


About 95% of penile cancers start in flat skin cells called squamous cells. Squamous cell carcinoma can start anywhere on the penis. Most of these cancers start on the [[prepuce]] or foreskin (in men who have not been circumcised) or on the [[glans]]. These tumors tend to grow slowly. If they're found at an early stage, they can usually be cured.
{| class="wikitable"
|-
!Stage
! Description
|-
| I
| Confined to glans of prepuce
|-
| II
|  Invasion into shaft or corpora


[[Squamous Cell Carcinoma of Penis]] may be classified according to [[Jackson's Staging System]] into number subtypes/groups: I, II, III, and IV.
|-
| III  
| Operable inguinal lymph node metastasis


'''Stage'''    '''Description'''
|-
| IV
| Tumor invades adjacent structures; inoperable inguinal lymph node metastasis


I                  Confined to glans of prepuce
|}
 
II                Invasion into shaft or corpora
 
III                Operable inguinal lymph node metastasis
 
IV                Tumor invades adjacent structures; inoperable inguinal lymph node metastasis


==Pathophysiology==
==Pathophysiology==
*The pathogenesis of Erythroplasia of Queyrat is characterized by [[squamous cell carcinoma]] in situ of the [[glans penis]]<ref name="Lookingbill">Marks, James G; Miller, Jeffery (2006). ''Lookingbill and Marks' Principles of Dermatology'' (4th ed.). Elsevier Inc. Page 63. ISBN 1-4160-3185-5.</ref>
*The [[pathogenesis]] of erythroplasia of Queyrat is characterized by [[squamous cell carcinoma]] ([[Squamous cell carcinoma|SCC]]) in situ of the [[glans penis]]:<ref name="Lookingbill">Marks, James G; Miller, Jeffery (2006). ''Lookingbill and Marks' Principles of Dermatology'' (4th ed.). Elsevier Inc. Page 63. ISBN 1-4160-3185-5.</ref>
It is a premalignant dermatosis that usually occurs on the glans penis and appears as a well-marginated erythematous velvety patch or plaque.
**It is a [[premalignant]] [[dermatosis]] that usually occurs on the [[glans penis]] and appears as a well-marginated [[erythematous]] velvety patch or [[plaque]].
**Analogous to [[Bowen's disease]], [[Infiltration (medical)|infiltration]], [[Nodular|nodularity]] or [[ulceration]] often suggest the possibility of progression to an [[Invasive (medical)|invasive]] [[squamous cell carcinoma]]. 
**[[Transformation]] of erythroplasia of Queyrat into an [[Invasive (medical)|invasive]] [[Squamous cell carcinoma|SCC]] is more common than in [[Bowen's disease|Bowen's disease]], with an [[Incidence (epidemiology)|incidence]] varying from 10% to 33%. This difference could be related to the [[mucosal]] location of the [[disease]].
**When [[Penis|penile]] [[submucosa]] is invaded, the rate of involvement of regional [[lymph nodes]] is about 20%.
**Clinically, the presence of [[ulceration]] and/or [[papillary]] [[lesions]] usually corresponds to progression into an [[Invasive (medical)|invasive]] [[carcinoma]].
===Histopathological Features===
*Low-grade (I-II)<ref name="HakenbergCompérat2015" />
**Well-differentiated [[Lesion|lesions]] show a thickened [[Hyperkeratosis|hyperkeratotic]], and [[Papillomatosis|papillomatous]] [[epidermis]]
**Downward fingerlike projection of atypical [[Squamous cell|squamous cells]] that often appear as concentrically arranged nests of [[Cells (biology)|cells]] surrounding [[keratin]] accumulations ([[keratin]] pearls).
*High-grade (III-IV)
**More poorly differentiated [[squamous cell carcinoma]]
**Shows little or no [[keratinization]]
**Increased [[nuclear]] [[pleomorphism]]
**[[Hyperchromicity|Hyperchromatic]]
**Deeper [[Invasive (medical)|invasion]]; may have areas of [[necrosis]] or [[superinfection]]


Analogous to Bowen's disease (BD), infiltration, nodularity or ulceration often suggest the possibility of conversion to an invasive squamous cell carcinoma. Transformation of EQ into an invasive SCC is more common than in BD, with an incidence varying from 10%to 33%. This difference could be related to the mucosal location of the disease. If the penile submucosa is invaded, the rate of involvement of regional lymph nodes is about 20%. Clinically, the presence of ulceration and/or papillary lesions usually corresponds to progression into an invasive carcinoma.  
{| align="right"
 
|[[File:Erythroplasia of Queyrat.png|thumb|none|300px|Clinical presentation of Erythroplasia of Queyrat [https://openi.nlm.nih.gov/detailedresult.php?img=PMC3981308_cp-2012-3-e63-g001&query=erythroplasia+of+queyrat&it=xg&req=4&npos=1 Source: Department of Urology, Mid-Western Regional Hospital, Dooradoyle, Limerick, Co. Limerick, Ireland - National library of medicine] ]]
The exact pathogenesis of [disease name] is not fully understood.
|}
 
OR
 
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
 
OR
 
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
 
OR
 
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
 
OR
 
 
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
 
OR
 
The progression to [disease name] usually involves the [molecular pathway].
 
OR
 
The pathophysiology of [disease/malignancy] depends on the histological subtype.


==Causes==
==Causes==
Besides old age and lack of circumcision, Erythroplasia of Queyrat has been linked to various factors including;
Besides old [[age]] and lack of [[Circumcise|circumcision]], erythroplasia of Queyrat has been linked to various factors including:
*chronic irritation from retained secretions under the foreskin
*[[Chronic (medical)|Chronic]] [[irritation]] from retained [[Secretion|secretions]] under the [[foreskin]]<ref name="pmid23667209">{{cite journal| author=Clark PE, Spiess PE, Agarwal N, Biagioli MC, Eisenberger MA, Greenberg RE et al.| title=Penile cancer: Clinical Practice Guidelines in Oncology. | journal=J Natl Compr Canc Netw | year= 2013 | volume= 11 | issue= 5 | pages= 594-615 | pmid=23667209 | doi= | pmc=4042432 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23667209  }} </ref>
*smegma
*Poor [[hygiene]]
*poor hygiene
*[[Smegma]]
*genital herpes simplex
*[[Herpes Genitalis|Genital herpes]] simplex
*heat, friction
*[[Heat]]
*trauma
*[[Friction]]
*HPV infection has also been hypothesized as a factor.
*[[Trauma]]
 
*[[Human papilloma virus]] ([[Human papilloma virus|HPV]]) infection, types 16, 18, 31, 33.
Disease name] may be caused by [cause1], [cause2], or [cause3].
 
OR
 
Common causes of [disease] include [cause1], [cause2], and [cause3].
 
OR


The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
==Differentiating Erythroplasia of Queyrat from Other Diseases==
 
*Erythroplasia of Queyrat must be differentiated from other diseases that cause [[squamous cell carcinoma|squamous cell carcinoma of penis]]:
OR
**[[Bowen's disease|Bowen's Disease]]<ref name="BradyMercurio2013">{{cite journal|last1=Brady|first1=Kimberly L.|last2=Mercurio|first2=Mary Gail|last3=Brown|first3=Marc D.|title=Malignant Tumors of the Penis|journal=Dermatologic Surgery|volume=39|issue=4|year=2013|pages=527–547|issn=1076-0512|doi=10.1111/dsu.12029}}</ref>
 
**Bowenoid Papulosis
The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click [[Pericarditis causes#Overview|here]].
**[[Verrucous carcinoma]]
 
==Differentiating ((Page name)) from Other Diseases==
Erythroplasia of Queyrat must be differentiated from other diseases that cause [[Squamous cell carcinoma of penis]].
Differentials include:
*Bowen's Disease
*Bowenoid Papulosis
*[[Verrucous carcinoma]]: A verrucous carcinoma growing on the penis is also known as Buschke-Lowenstein tumor.  This is an uncommon form of squamous cell cancer that can start in the skin in many areas. This cancer looks a lot like a large genital wart. Verrucous carcinomas tend to grow slowly but can sometimes get very large. They can grow deep into nearby tissue, but they rarely spread to other parts of the body.


==Epidemiology and Demographics==
==Epidemiology and Demographics==
Penile SCC is an uncommon disease in most Western countries, in which it constitutes a small proportion of the total cancers. However, it represents a significant public health problem in several parts of the world where early circumcision and good genital hygiene are less commonly practiced.  
*Israel and the United States as well as other industrialized countries, where [[infant]] [[Circumcise|circumcision]] is common, the [[Incidence (epidemiology)|incidence]] of [[carcinoma of the penis|penile squamous cell carcinoma]] is less than 1 per 100,000 [[Male|males]].<ref name="pmid18607597">{{cite journal| author=Bleeker MC, Heideman DA, Snijders PJ, Horenblas S, Dillner J, Meijer CJ| title=Penile cancer: epidemiology, pathogenesis and prevention. | journal=World J Urol | year= 2009 | volume= 27 | issue= 2 | pages= 141-50 | pmid=18607597 | doi=10.1007/s00345-008-0302-z | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18607597  }} </ref>
===Age===
*[[Squamous cell cancer]] accounts for more than 95% of cases of [[penile cancer]]. This represents a significant [[public health]] problem in several parts of the world where early [[Circumcise|circumcision]] and good [[genital]] [[hygiene]] are less commonly practiced.
*Erythroplasia of Queyrat is more commonly observed among patients aged 40 years old.
===Gender===
*Males are affected with Erythroplasia of Queyrat.
 
The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.
 
OR
 
In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.
 
OR
 
In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.
 
 
 
Patients of all age groups may develop [disease name].
 
OR
 
The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.
 
OR
 
[Disease name] commonly affects individuals younger than/older than [number of years] years of age.
 
OR
 
[Chronic disease name] is usually first diagnosed among [age group].
 
OR


[Acute disease name] commonly affects [age group].
*Erythroplasia of Queyrat is more commonly observed among [[patients]] [[Age|aged]] 60 years old.


 
*[[Male|Males]] are affected with erythroplasia of Queyrat.
 
There is no racial predilection to [disease name].
 
OR
 
[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].
 
 
 
[Disease name] affects men and women equally.
 
OR
 
[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.
 
 
 
The majority of [disease name] cases are reported in [geographical region].
 
OR
 
[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].


==Risk Factors==
==Risk Factors==
*Most common risk factor in the development of Erythroplasia of Queyrat is uncircumcised penis.
Most common [[risk factor]] in the [[development]] of erythroplasia of Queyrat is [[Circumcised|uncircumcised]] [[penis]]. Other common [[Risk factor|risk factors]] in the development of erythroplasia of Queyrat include:<ref name="BleekerHeideman2008">{{cite journal|last1=Bleeker|first1=M. C. G.|last2=Heideman|first2=D. A. M.|last3=Snijders|first3=P. J. F.|last4=Horenblas|first4=S.|last5=Dillner|first5=J.|last6=Meijer|first6=C. J. L. M.|title=Penile cancer: epidemiology, pathogenesis and prevention|journal=World Journal of Urology|volume=27|issue=2|year=2008|pages=141–150|issn=0724-4983|doi=10.1007/s00345-008-0302-z}}</ref> <ref name="DouglawiMasterson2017">{{cite journal|last1=Douglawi|first1=Antoin|last2=Masterson|first2=Timothy A.|title=Updates on the epidemiology and risk factors for penile cancer|journal=Translational Andrology and Urology|volume=6|issue=5|year=2017|pages=785–790|issn=22234683|doi=10.21037/tau.2017.05.19}}</ref>
There are no established risk factors for [disease name].


OR
*[[Smoking]]
 
*[[Obesity]]
The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].
*Low [[socio-economic status]]
 
*Multiple [[Sex (activity)|sex]] partners
OR
*[[Immunosuppression]]
 
*[[Ultraviolet light|Ultraviolet (UV) light exposure]]
Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
*[[Human Papilloma Virus|Human papilloma virus]] ([[HPV]])
 
*[[Phimosis]]
OR
*[[Zoon balanitis|Zoon balantis]]
 
*Underlying [[Dermatosis|dermatoses]] ([[Lichen Planus|lichen planus]])
Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.
*[[Chronic inflammation]], [[irritation]] or [[infection]]


==Screening==
==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].
There is insufficient [[evidence]] to recommend [[Screening (medicine)|routine screening]] for erythroplasia of Queyrat.<ref name="SalamiMontgomery2017">{{cite journal|last1=Salami|first1=Simpa S.|last2=Montgomery|first2=Jeffrey S.|title=Surveillance strategies in the management of penile cancer|journal=Translational Andrology and Urology|volume=6|issue=5|year=2017|pages=868–873|issn=22234683|doi=10.21037/tau.2017.06.04}}</ref>
 
OR
 
According to the [guideline name], screening for [disease name] is not recommended.
 
OR
 
According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].


==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
* If left untreated, patients with erythroplasia of Queyrat may progress to develop [[Invasive (medical)|invasive]] [[squamous cell carcinoma]] of the [[penis]].<ref name="SchlenkerSchneede2019">{{cite journal|last1=Schlenker|first1=Boris|last2=Schneede|first2=Peter|title=The Role of Human Papilloma Virus in Penile Cancer Prevention and New Therapeutic Agents|journal=European Urology Focus|volume=5|issue=1|year=2019|pages=42–45|issn=24054569|doi=10.1016/j.euf.2018.09.010}}</ref>
 
OR
 
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
 
OR
 
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.


==Diagnosis==
==Diagnosis==
===Diagnostic Study of Choice===
===Diagnostic Study of Choice===
The diagnosis of [Erythroplasia of Queyrat] is confirmed with histological examination.  at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*There are no widely recommended [[Screening test|screening tests]] for [[penile cancer]], and many [[Penile cancer|penile cancers]] can be found early, when they're small and before they have [[Spread of the cancer|spread]] to other parts of the [[body]].<ref name="Damjanov2009">{{cite journal|last1=Damjanov|first1=Ivan|title=The Male Genital System|year=2009|pages=329–338|doi=10.1016/B978-0-323-05594-9.00016-7}}</ref>
 
*The [[diagnosis]] of erythroplasia of Queyrat is confirmed with [[histological]] [[examination]].  
Delays in the diagnosis and treatment of [[Erythroplasia of Queyrat]] are common because of two main factors.   
*Delays in the [[diagnosis]] and treatment of [[erythroplasia of Queyrat]] are common because of two main factors.   
*Early penile SCC often has a varying clinical presentation, mimicking benign disorders.  
**Early [[Penis|penile]] [[Squamous cell carcinoma|SCC]] often has a varying [[Clinical|clinical presentation]], mimicking [[benign]] [[Disorder (medicine)|disorders]].  
*Patients often tend to disregard minimal genital lesions for a long time before seeking medical attention.  
**[[Patient|Patients]] often tend to disregard minimal [[Genital area|genital]] [[lesions]] for a long time before seeking [[medical]] attention.  
Delay in diagnosis of more than 1 year has been observed in 15% to 20% of patients, the reasons usually being embarrassment, guilt, fear, personal neglect, or ignorance.
Delay in [[diagnosis]] of more than 1 year has been observed in 15% to 20% of [[Patient|patients]], the reasons usually being [[embarrassment]], guilt, [[fear]], personal neglect, or ignorance.
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
There are no established criteria for the diagnosis of [disease name].
 
=== Symptoms ===
*Symptoms of Erythroplasia of Queyrat may include the following:
:*Red rash on the tip of the penis
:*Irritation on the tip of the penis


===History and Symptoms===
===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.
*The [[hallmark]] of erythroplasia of Queyrat is a [[Erythematous|red]], velvety appearing [[rash]] beneath the [[Penis|penile]] [[foreskin]].{{cite web |url=http://www.cancer.ca/en/cancer-information/cancer-type/penile/penile-cancer/precancerous-conditions/?region=bc |title=Precancerous conditions of the penis - Canadian Cancer Society |format= |work= |accessdate=}} 
*The [[Lesion|lesions]] are usually [[solitary]] and occasionally erode or [[Ulcerated lesion|ulcerate]], but [[pain]] is uncommon.
*A positive [[History and Physical examination|history]] of lack of [[Circumcise|circumcision]] and [[lesion]] [[growth]] are suggestive of erythroplasia of Queyrat.  
*The most common [[Symptom|symptoms]] of this [[precancerous]] condition include:


OR
'''Penile Skin Changes'''
*[[Itching]] and [[Dysuria|burning]] under [[foreskin]]
*Thickening of [[skin]]
*[[Skin]] discoloration
*[[Lump|Lumps]]
*[[Ulcer|Ulcers]]
*[[Rash]]; velvety red under [[foreskin]]
*[[Bleeding]] under [[foreskin]]
*Foul smelling [[discharge]] under [[foreskin]]


The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
'''Genitourinary Changes'''
*[[Dysuria]]
*Weak [[Urine|urine stream]]
*[[Loss of sensation]] in [[glans]]
*Inability to fully pull back [[foreskin]] over [[glans]]


===Physical Examination===
===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
*The physician will then perform a physical examination of the genital area for possible signs of penile cancer or other health problems.
 
*Penile lesions (sores) usually affect the skin on the penis.
OR
*This is followed by examination and palpation of the lymph nodes in patient's groin to see if they are swollen.
 
*If symptoms and/or the exam suggest you might have penile cancer, other tests will be needed. These might include a biopsy and imaging tests.
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
*[[Patient|Patients]] with erythroplasia of Queyrat usually appear [[Erythematous|red]], velvety appearing [[rash]] beneath the [[Penis|penile]] [[foreskin]].
 
*[[Physical examination]] of [[Patient|patients]] with erythroplasia of Queyrat is usually remarkable for [[Penis|penile]] [[skin changes]] including [[Erythematous|red]], [[Ulceration|ulcerating]], [[bleeding]], and [[Induration|indurated]] [[lesion]] on the [[glans]] or [[Erythematous|red]] [[Vegetation (pathology)|vegetating]] [[mass]] on the [[Glans penis|glans]].
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


===Laboratory Findings===
===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].


OR
There are no [[diagnostic]] [[Laboratory findings template|laboratory findings]] associated with erythroplasia of Queyrat.


Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
===Treatment===
 
OR
 
[Test] is usually normal among patients with [disease name].
 
OR
 
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
 
OR
 
There are no diagnostic laboratory findings associated with [disease name].
 
===Electrocardiogram===
There are no ECG findings associated with [disease name].
 
OR
 
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
===X-ray===
There are no x-ray findings associated with [disease name].
 
OR
 
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 
===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound  findings associated with [disease name].
 
OR
 
Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 
===CT scan===
There are no CT scan findings associated with [disease name].
 
OR
 
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 
===MRI===
There are no MRI findings associated with [disease name].
 
OR
 
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 
===Other Imaging Findings===
There are no other imaging findings associated with [disease name].
 
OR
 
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].
 
OR
 
[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].
 
== Treatment ==
=== Medical Therapy ===
=== Medical Therapy ===
*There are several non-invasive treatment options for erythroplasia of Queyrat such as photodynamic therapy, cryosurgery and applying various kinds of topical agents.  The mainstay of therapy for Erythroplasia of Queyrat is  imiquimod or 5-fluorouracil for several weeks to months. A therapeutic regimen of 5 per cent 5-fluorouracil cream applied to lesion(s) twice daily for four to five weeks has produced a high cure rate and maintained penile integrity and function.
*The mainstay of [[therapy]] for erythroplasia of Queyrat is  [[Imiquimod]] or [[5-fluorouracil|5-fluorouracil]] for several weeks to months.<ref name="ChoiChoi2009">{{cite journal|last1=Choi|first1=Jee Woong|last2=Choi|first2=Mira|last3=Cho|first3=Kwang Hyun|title=A Case of Erythroplasia of Queyrat Treated with Imiquimod 5% Cream and Excision|journal=Annals of Dermatology|volume=21|issue=4|year=2009|pages=419|issn=1013-9087|doi=10.5021/ad.2009.21.4.419}}</ref>
 
*A [[therapeutic]] regimen of 5% [[5-fluorouracil]] ([[5-fluorouracil|5-FU]]) [[Cream (pharmaceutical)|cream]] applied to [[lesion]](s) twice daily for four to five weeks has produced a high [[cure]] [[rate]] and maintained [[Penis|penile]] integrity and [[Function (biology)|function]].<ref name="AntônioAntônio2016">{{cite journal|last1=Antônio|first1=João Roberto|last2=Antônio|first2=Carlos Roberto|last3=Trídico|first3=Lívia Arroyo|last4=Alves|first4=Fernanda Tomé|last5=Rollemberg|first5=Ivan|title=Erythroplasia of Queyrat treated with topical 5-fluorouracil|journal=Anais Brasileiros de Dermatologia|volume=91|issue=5 suppl 1|year=2016|pages=42–44|issn=0365-0596|doi=10.1590/abd1806-4841.20164595}}</ref> 
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
*There are several [[Non-invasive (medical)|non-invasive]] treatment options for erythroplasia of Queyrat, including:
 
**[[Photodynamic therapy]]
OR
**[[Cryosurgery]]  
 
**[[Topical application|Topical agents]]
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
*[[Pharmacological|Pharmacologic]] [[medical]] [[therapy]] is recommended among all [[Patient|patients]] who develop erythroplasia of Queyrat.
 
OR
 
The majority of cases of [disease name] are self-limited and require only supportive care.
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.
 
OR
 
The mainstay of treatment for [disease name] is [therapy].
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
OR
 
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
 
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].


=== Surgery ===
=== Surgery ===
[[Surgery]] is the mainstay treatment of choice for erythroplasia of Queyrat,  and is often the only treatment needed for early stage [[Penile cancer|penile cancers]].  Although, authors have used 5% [[5-Fluorouracil|5-FU]] cream with some success. 
*[[Circumcise|Circumcision]]- recommended when the [[lesion]] is limited to [[Preputial gland|preputial]] [[skin]].
*[[Mohs micrographic surgery|Mohs microscopic surgery]]- for [[Patient|patients]] with  aggressive forms of erythroplasia of Queyrat this form of [[Surgery|surgical]] [[excision]] is effective.
*[[Wide local excision]]- removes the [[tumor]] along with a margin of [[normal]] [[tissue]] around it.
*[[Laser surgery]]- an intense, narrow beam of light (called a [[laser]] beam) to destroy [[Cancer (medicine)|cancer]] [[Cells (biology)|cells]].
*[[Cryosurgery]]- extreme cold to freeze and destroy [[Tissue (biology)|tissue]].


Surgical excision is the treatment of choice, although some authors have used 5% 5-FU cream with some success.  When the lesion is limited to preputial skin, circumcision is recommended.  Mohs microscopic surgery is also effective and can be performed for patients with  aggressive forms of Erythroplasia of Queyrat. 
===Prevention===
 
There are no established measures for the prevention of erythroplasia of Queyrat.
Surgical intervention is not recommended for the management of [disease name].
 
OR
 
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]
 
OR
 
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
 
OR
 
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
 
OR
 
Surgery is the mainstay of treatment for [disease or malignancy].
 
===Primary Prevention===
There are no established measures for the primary prevention of [[Erythroplasia of Queyrat]].  However, circumcision at an early age is thought to prevent its development.
 
OR
 
There are no available vaccines against [disease name].
 
OR
 
Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
 
OR
 
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].
 
===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].
 
OR
 
Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].


==References==
==References==

Latest revision as of 16:40, 27 February 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Swathi Venkatesan, M.B.B.S.[2]

Synonyms and keywords: EQ

Overview

Erythroplasia of Queyrat is a penile squamous cell carcinoma in situ named after Louis Queyrat, a French dermatologist who was head of the dermatology service of l'Hôpital Ricord, a venereal hospital in Paris, now Hôpital Cochin. The pathogenesis of erythroplasia of Queyrat is characterized as a precancerous lesion of squamous cell carcinoma in situ of the glans penis and inner prepuce or foreskin. Erythroplasia of Queyrat is most commonly observed among white male patients aged 60 years old and older with Human papilloma virus (HPV) infection or chronic irritation and lack of hygiene of pubic area. The most common risk factor in the development of erythroplasia of Queyrat is an uncircumcised penis. The mainstay of therapy for erythroplasia of Queyrat is imiquimod or 5-fluorouracil for several weeks to months.

Historical Perspective

  • Erythroplasia of Queyrat was first discovered and named after Louis Queyrat.[1]
  • Louis Queyrat was French dermatologist who was head of the dermatology service of l'Hôpital Ricord, a venereal hospital in Paris, now Hôpital Cochin.
  • Tarnovsky originally described erythroplasia of Queyrat in 1891, but it was Queyrat who originated the term erythroplasia in 1911.

Classification

Jackson's Staging System for Squamous Cell Carcinoma of Penis

Stage Description
I Confined to glans of prepuce
II Invasion into shaft or corpora
III Operable inguinal lymph node metastasis
IV Tumor invades adjacent structures; inoperable inguinal lymph node metastasis

Pathophysiology

Histopathological Features

Clinical presentation of Erythroplasia of Queyrat Source: Department of Urology, Mid-Western Regional Hospital, Dooradoyle, Limerick, Co. Limerick, Ireland - National library of medicine

Causes

Besides old age and lack of circumcision, erythroplasia of Queyrat has been linked to various factors including:

Differentiating Erythroplasia of Queyrat from Other Diseases

Epidemiology and Demographics

  • Erythroplasia of Queyrat is more commonly observed among patients aged 60 years old.
  • Males are affected with erythroplasia of Queyrat.

Risk Factors

Most common risk factor in the development of erythroplasia of Queyrat is uncircumcised penis. Other common risk factors in the development of erythroplasia of Queyrat include:[8] [9]

Screening

There is insufficient evidence to recommend routine screening for erythroplasia of Queyrat.[10]

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic Study of Choice

Delay in diagnosis of more than 1 year has been observed in 15% to 20% of patients, the reasons usually being embarrassment, guilt, fear, personal neglect, or ignorance.

History and Symptoms

  • The hallmark of erythroplasia of Queyrat is a red, velvety appearing rash beneath the penile foreskin."Precancerous conditions of the penis - Canadian Cancer Society".
  • The lesions are usually solitary and occasionally erode or ulcerate, but pain is uncommon.
  • A positive history of lack of circumcision and lesion growth are suggestive of erythroplasia of Queyrat.
  • The most common symptoms of this precancerous condition include:

Penile Skin Changes

Genitourinary Changes

Physical Examination

  • The physician will then perform a physical examination of the genital area for possible signs of penile cancer or other health problems.
  • Penile lesions (sores) usually affect the skin on the penis.
  • This is followed by examination and palpation of the lymph nodes in patient's groin to see if they are swollen.
  • If symptoms and/or the exam suggest you might have penile cancer, other tests will be needed. These might include a biopsy and imaging tests.
  • Patients with erythroplasia of Queyrat usually appear red, velvety appearing rash beneath the penile foreskin.
  • Physical examination of patients with erythroplasia of Queyrat is usually remarkable for penile skin changes including red, ulcerating, bleeding, and indurated lesion on the glans or red vegetating mass on the glans.

Laboratory Findings

There are no diagnostic laboratory findings associated with erythroplasia of Queyrat.

Treatment

Medical Therapy

Surgery

Surgery is the mainstay treatment of choice for erythroplasia of Queyrat, and is often the only treatment needed for early stage penile cancers. Although, authors have used 5% 5-FU cream with some success.

Prevention

There are no established measures for the prevention of erythroplasia of Queyrat.

References

  1. ↑ Weidner, Noel (2009). Modern surgical pathology. Philadelphia, PA: Saunders/Elsevier. ISBN 9781437719581.
  2. ↑ 2.0 2.1 Hakenberg, Oliver W.; Compérat, Eva M.; Minhas, Suks; Necchi, Andrea; Protzel, Chris; Watkin, Nick (2015). "EAU Guidelines on Penile Cancer: 2014 Update". European Urology. 67 (1): 142–150. doi:10.1016/j.eururo.2014.10.017. ISSN 0302-2838.
  3. ↑ Lynch DF Jr. Cancer of the Penis. In: Kufe DW, Pollock RE, Weichselbaum RR, et al., editors. Holland-Frei Cancer Medicine. 6th edition. Hamilton (ON): BC Decker; 2003. Available from: https://www.ncbi.nlm.nih.gov/books/NBK13419/
  4. ↑ Marks, James G; Miller, Jeffery (2006). Lookingbill and Marks' Principles of Dermatology (4th ed.). Elsevier Inc. Page 63. ISBN 1-4160-3185-5.
  5. ↑ Clark PE, Spiess PE, Agarwal N, Biagioli MC, Eisenberger MA, Greenberg RE; et al. (2013). "Penile cancer: Clinical Practice Guidelines in Oncology". J Natl Compr Canc Netw. 11 (5): 594–615. PMC 4042432. PMID 23667209.
  6. ↑ Brady, Kimberly L.; Mercurio, Mary Gail; Brown, Marc D. (2013). "Malignant Tumors of the Penis". Dermatologic Surgery. 39 (4): 527–547. doi:10.1111/dsu.12029. ISSN 1076-0512.
  7. ↑ Bleeker MC, Heideman DA, Snijders PJ, Horenblas S, Dillner J, Meijer CJ (2009). "Penile cancer: epidemiology, pathogenesis and prevention". World J Urol. 27 (2): 141–50. doi:10.1007/s00345-008-0302-z. PMID 18607597.
  8. ↑ Bleeker, M. C. G.; Heideman, D. A. M.; Snijders, P. J. F.; Horenblas, S.; Dillner, J.; Meijer, C. J. L. M. (2008). "Penile cancer: epidemiology, pathogenesis and prevention". World Journal of Urology. 27 (2): 141–150. doi:10.1007/s00345-008-0302-z. ISSN 0724-4983.
  9. ↑ Douglawi, Antoin; Masterson, Timothy A. (2017). "Updates on the epidemiology and risk factors for penile cancer". Translational Andrology and Urology. 6 (5): 785–790. doi:10.21037/tau.2017.05.19. ISSN 2223-4683.
  10. ↑ Salami, Simpa S.; Montgomery, Jeffrey S. (2017). "Surveillance strategies in the management of penile cancer". Translational Andrology and Urology. 6 (5): 868–873. doi:10.21037/tau.2017.06.04. ISSN 2223-4683.
  11. ↑ Schlenker, Boris; Schneede, Peter (2019). "The Role of Human Papilloma Virus in Penile Cancer Prevention and New Therapeutic Agents". European Urology Focus. 5 (1): 42–45. doi:10.1016/j.euf.2018.09.010. ISSN 2405-4569.
  12. ↑ Damjanov, Ivan (2009). "The Male Genital System": 329–338. doi:10.1016/B978-0-323-05594-9.00016-7.
  13. ↑ Choi, Jee Woong; Choi, Mira; Cho, Kwang Hyun (2009). "A Case of Erythroplasia of Queyrat Treated with Imiquimod 5% Cream and Excision". Annals of Dermatology. 21 (4): 419. doi:10.5021/ad.2009.21.4.419. ISSN 1013-9087.
  14. ↑ Antônio, João Roberto; Antônio, Carlos Roberto; Trídico, Lívia Arroyo; Alves, Fernanda Tomé; Rollemberg, Ivan (2016). "Erythroplasia of Queyrat treated with topical 5-fluorouracil". Anais Brasileiros de Dermatologia. 91 (5 suppl 1): 42–44. doi:10.1590/abd1806-4841.20164595. ISSN 0365-0596.
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