Erythroplasia of Queyrat: Difference between revisions
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{{SI}} | {{SI}} | ||
{{CMG}} {{AE}} {{Swathi}} | {{CMG}}; {{AE}} {{Swathi}} | ||
{{SK}} EQ | {{SK}} EQ | ||
==Overview== | ==Overview== | ||
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 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== | ||
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==Classification== | ==Classification== | ||
*Erythroplasia of Queyrat is classified as a [[precancerous]] lesion. | *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 | *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]]. | *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> | *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> | ||
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===Jackson's Staging System for Squamous Cell Carcinoma of Penis=== | ===Jackson's Staging System for Squamous Cell Carcinoma of Penis=== | ||
*[[Squamous cell carcinoma|Squamous | *[[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> | ||
{| class="wikitable" | {| class="wikitable" | ||
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==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]]. | **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 | **[[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%. | **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]]. | **Clinically, the presence of [[ulceration]] and/or [[papillary]] [[lesions]] usually corresponds to progression into an [[Invasive (medical)|invasive]] [[carcinoma]]. | ||
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==Causes== | ==Causes== | ||
Besides old [[age]] and lack of [[Circumcise|circumcision]], | Besides old [[age]] and lack of [[Circumcise|circumcision]], erythroplasia of Queyrat has been linked to various factors including: | ||
*[[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> | *[[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> | ||
*Poor [[hygiene]] | *Poor [[hygiene]] | ||
*[[Smegma]] | *[[Smegma]] | ||
*[[Herpes Genitalis|Genital herpes]] simplex | *[[Herpes Genitalis|Genital herpes]] simplex | ||
*[[Heat]] | *[[Heat]] | ||
*[[Friction]] | |||
*[[Trauma]] | *[[Trauma]] | ||
*[[Human | *[[Human papilloma virus]] ([[Human papilloma virus|HPV]]) infection, types 16, 18, 31, 33. | ||
==Differentiating Erythroplasia of Queyrat from Other Diseases== | ==Differentiating Erythroplasia of Queyrat from Other Diseases== | ||
*Erythroplasia of Queyrat must be differentiated from other diseases that cause [[ | *Erythroplasia of Queyrat must be differentiated from other diseases that cause [[squamous cell carcinoma|squamous cell carcinoma of penis]]: | ||
**[[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> | **[[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 | **Bowenoid Papulosis | ||
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==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
*Israel and the United States as well as other industrialized countries, where [[infant]] [[Circumcise|circumcision]] is common, the [[Incidence (epidemiology)|incidence]] of [[ | *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> | ||
*[[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. | |||
*[[Squamous cell cancer]] accounts for more than 95% of cases of [[penile cancer]]. | |||
*Erythroplasia of Queyrat is more commonly observed among [[patients]] [[Age|aged]] 60 years old. | *Erythroplasia of Queyrat is more commonly observed among [[patients]] [[Age|aged]] 60 years old. | ||
*[[Male|Males]] are affected with erythroplasia of Queyrat. | |||
*[[Male|Males]] are affected with | |||
==Risk Factors== | ==Risk Factors== | ||
Most common [[risk factor]] in the [[development]] of | 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> | ||
*[[Smoking]] | *[[Smoking]] | ||
*[[Obesity]] | *[[Obesity]] | ||
*Low [[ | *Low [[socio-economic status]] | ||
*Multiple [[Sex (activity)|sex]] partners | *Multiple [[Sex (activity)|sex]] partners | ||
*[[Immunosuppression]] | *[[Immunosuppression]] | ||
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==Screening== | ==Screening== | ||
There is insufficient [[evidence]] to recommend [[Screening (medicine)|routine screening]] for | 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> | ||
==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
If left untreated, patients with | * 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> | ||
==Diagnosis== | ==Diagnosis== | ||
===Diagnostic Study of Choice=== | ===Diagnostic Study of Choice=== | ||
*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> | *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 | *The [[diagnosis]] of erythroplasia of Queyrat is confirmed with [[histological]] [[examination]]. | ||
Delays in the [[diagnosis]] and treatment of [[ | *Delays in the [[diagnosis]] and treatment of [[erythroplasia of Queyrat]] are common because of two main factors. | ||
*Early [[Penis|penile]] [[Squamous cell carcinoma|SCC]] often has a varying [[Clinical|clinical presentation]], mimicking [[benign]] [[Disorder (medicine)|disorders]]. | **Early [[Penis|penile]] [[Squamous cell carcinoma|SCC]] often has a varying [[Clinical|clinical presentation]], mimicking [[benign]] [[Disorder (medicine)|disorders]]. | ||
*[[Patient|Patients]] often tend to disregard minimal [[Genital area|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 [[Patient|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. | ||
=== Symptoms === | ===History and Symptoms=== | ||
*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: | |||
'''Penile Skin Changes''' | '''Penile Skin Changes''' | ||
*[[Itching]] and [[Dysuria|burning]] under [[foreskin]] | *[[Itching]] and [[Dysuria|burning]] under [[foreskin]] | ||
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*Foul smelling [[discharge]] under [[foreskin]] | *Foul smelling [[discharge]] under [[foreskin]] | ||
'''Genitourinary Changes''' | |||
* | *[[Dysuria]] | ||
* | *Weak [[Urine|urine stream]] | ||
* | *[[Loss of sensation]] in [[glans]] | ||
*Inability to fully pull back [[foreskin]] over [[glans]] | |||
===Physical Examination=== | ===Physical Examination=== | ||
[[Patient|Patients]] with | *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. | |||
*[[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]]. | |||
===Laboratory Findings=== | ===Laboratory Findings=== | ||
There are no [[diagnostic]] [[Laboratory findings template|laboratory findings]] associated with | There are no [[diagnostic]] [[Laboratory findings template|laboratory findings]] associated with erythroplasia of Queyrat. | ||
=== | ===Treatment=== | ||
= | |||
=== Medical Therapy === | === Medical Therapy === | ||
*The mainstay of [[therapy]] for | *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]] [[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> | *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 are several [[Non-invasive (medical)|non-invasive]] treatment options for | *There are several [[Non-invasive (medical)|non-invasive]] treatment options for erythroplasia of Queyrat, including: | ||
**[[Photodynamic therapy]] | **[[Photodynamic therapy]] | ||
**[[Cryosurgery]] | **[[Cryosurgery]] | ||
**[[Topical agents]] | **[[Topical application|Topical agents]] | ||
*[[Pharmacological|Pharmacologic]] [[medical]] [[therapy]] is recommended among all [[Patient|patients]] who develop | *[[Pharmacological|Pharmacologic]] [[medical]] [[therapy]] is recommended among all [[Patient|patients]] who develop erythroplasia of Queyrat. | ||
=== Surgery === | === Surgery === | ||
[[Surgery]] is the mainstay treatment of choice for | [[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]]. | *[[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 | *[[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. | *[[Wide local excision]]- removes the [[tumor]] along with a margin of [[normal]] [[tissue]] around it. | ||
*[[Laser surgery]]- | *[[Laser surgery]]- an intense, narrow beam of light (called a [[laser]] beam) to destroy [[Cancer (medicine)|cancer]] [[Cells (biology)|cells]]. | ||
*[[Cryosurgery]] | *[[Cryosurgery]]- extreme cold to freeze and destroy [[Tissue (biology)|tissue]]. | ||
=== | ===Prevention=== | ||
There are no established measures for the | There are no established measures for the prevention of erythroplasia of Queyrat. | ||
==References== | ==References== | ||
Latest revision as of 16:40, 27 February 2019
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
- Erythroplasia of Queyrat is classified as a precancerous lesion.
- 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.[2]
- Depending on the location of the CIS on penis, doctors may use other names for the disease.
- CIS of the glans or prepuce is called erythroplasia of Queyrat, presents as erythroplakia.
- 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.
Jackson's Staging System for Squamous Cell Carcinoma of Penis
- Squamous cell carcinoma of penis may be classified according to Jackson's Staging System into number subtypes/groups:[3]
| 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
- The pathogenesis of erythroplasia of Queyrat is characterized by squamous cell carcinoma (SCC) in situ of the glans penis:[4]
- 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, nodularity or ulceration often suggest the possibility of progression to an invasive squamous cell carcinoma.
- Transformation of erythroplasia of Queyrat into an invasive SCC is more common than in Bowen's disease, with an incidence varying from 10% to 33%. This difference could be related to the mucosal location of the disease.
- When 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.
Histopathological Features
- Low-grade (I-II)[2]
- Well-differentiated lesions show a thickened hyperkeratotic, and papillomatous epidermis
- Downward fingerlike projection of atypical squamous cells that often appear as concentrically arranged nests of cells surrounding keratin accumulations (keratin pearls).
- High-grade (III-IV)
- More poorly differentiated squamous cell carcinoma
- Shows little or no keratinization
- Increased nuclear pleomorphism
- Hyperchromatic
- Deeper invasion; may have areas of necrosis or superinfection
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Causes
Besides old age and lack of circumcision, erythroplasia of Queyrat has been linked to various factors including:
- Chronic irritation from retained secretions under the foreskin[5]
- Poor hygiene
- Smegma
- Genital herpes simplex
- Heat
- Friction
- Trauma
- Human papilloma virus (HPV) infection, types 16, 18, 31, 33.
Differentiating Erythroplasia of Queyrat from Other Diseases
- Erythroplasia of Queyrat must be differentiated from other diseases that cause squamous cell carcinoma of penis:
- Bowen's Disease[6]
- Bowenoid Papulosis
- Verrucous carcinoma
Epidemiology and Demographics
- Israel and the United States as well as other industrialized countries, where infant circumcision is common, the incidence of penile squamous cell carcinoma is less than 1 per 100,000 males.[7]
- 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 circumcision and good genital hygiene are less commonly practiced.
- 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]
- Smoking
- Obesity
- Low socio-economic status
- Multiple sex partners
- Immunosuppression
- Ultraviolet (UV) light exposure
- Human papilloma virus (HPV)
- Phimosis
- Zoon balantis
- Underlying dermatoses (lichen planus)
- Chronic inflammation, irritation or infection
Screening
There is insufficient evidence to recommend routine screening for erythroplasia of Queyrat.[10]
Natural History, Complications, and Prognosis
- If left untreated, patients with erythroplasia of Queyrat may progress to develop invasive squamous cell carcinoma of the penis.[11]
Diagnosis
Diagnostic Study of Choice
- There are no widely recommended screening tests for penile cancer, and many penile cancers can be found early, when they're small and before they have spread to other parts of the body.[12]
- 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.
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
- Itching and burning under foreskin
- Thickening of skin
- Skin discoloration
- Lumps
- Ulcers
- Rash; velvety red under foreskin
- Bleeding under foreskin
- Foul smelling discharge under foreskin
Genitourinary Changes
- Dysuria
- Weak urine stream
- Loss of sensation in glans
- Inability to fully pull back foreskin over glans
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
- The mainstay of therapy for erythroplasia of Queyrat is Imiquimod or 5-fluorouracil for several weeks to months.[13]
- A therapeutic regimen of 5% 5-fluorouracil (5-FU) cream applied to lesion(s) twice daily for four to five weeks has produced a high cure rate and maintained penile integrity and function.[14]
- There are several non-invasive treatment options for erythroplasia of Queyrat, including:
- Pharmacologic medical therapy is recommended among all patients who develop erythroplasia of Queyrat.
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.
- Circumcision- recommended when the lesion is limited to preputial skin.
- Mohs microscopic surgery- for patients with aggressive forms of erythroplasia of Queyrat this form of 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 cells.
- Cryosurgery- extreme cold to freeze and destroy tissue.
Prevention
There are no established measures for the prevention of erythroplasia of Queyrat.
References
- ↑ Weidner, Noel (2009). Modern surgical pathology. Philadelphia, PA: Saunders/Elsevier. ISBN 9781437719581.
- ↑ 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.
- ↑ 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/
- ↑ Marks, James G; Miller, Jeffery (2006). Lookingbill and Marks' Principles of Dermatology (4th ed.). Elsevier Inc. Page 63. ISBN 1-4160-3185-5.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Damjanov, Ivan (2009). "The Male Genital System": 329–338. doi:10.1016/B978-0-323-05594-9.00016-7.
- ↑ 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.
- ↑ 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.