Carcinoma of the penis differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Carcinoma of the penis must be differentiated from condyloma acuminata, penile intraepithelial neoplasia (PeIN), balanitis xerotica obliterans, buschke-Lowenstein tumour, bowenoid papulosis, and leukoplakia.

Differential Diagnosis

Carcinoma of the penis must be differentiated from:

• Condyloma acuminata

• • a common sexually transmitted disease caused by a virus belonging to the human papilloma virus (HPV) group
  • Lesions normally grow as a papilloma and are usually found on the glans, prepuce, or shaft of the penis
  • Lesions are benign, caused by low-risk HPV 6/11
  • Mixed infections with high-risk HPV types are relatively common
  • Progression to malignancy is rare.

• Precancerous conditions

• Penile intraepithelial neoplasia (PeIN)
• Balanitis xerotica obliterans (BXO) also known as lichen sclerosis
  • A precancerous skin condition localized to the glans and the prepuce
  • Presents as white atrophic patches
  • The secondary development of phimosis inhibits washing and prevents early diagnostics of possible malignancy development on the glans or inside of the prepuce
  • A radical circumcision should therefore be performed for this disease
• Buschke-Lowenstein tumour
• Bowenoid papulosis
  • Multiple, slightly elevated, red to violet or brownish papules, on the penis shaft and scrotum
  • Very rare, is preferably seen young men
  • May regress without treatment
  • Caused by high-risk HPV, most commonly HPV 16
  • Histologically cannot be separated from undifferentiated PeIN
• Leukoplakia
  • Rare
  • Appear as a white hypertrophic or atrophic patch and usually occur secondary to chronic irritation
  • Develops in the meatus
  • Biopsy is necessary to exclude cancer and intraepithelial neoplasia (PeIN)