Carcinoma of the penis differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1],  Swathi Venkatesan, M.B.B.S.[2]

## Overview

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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

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Carcinoma of the penis must be differentiated from:[1][2]

* Noncancerous conditions

* 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 [3]

* Penile intraepithelial neoplasia (PeIN)
* most common precancerous condition of the penis
* General term used to describe precancerous conditions of the penis that may develop into invasive squamous cell carcinoma (SCC) if they are not treated
* Refers to abnormal cell changes, called carcinoma in situ, that occur on the skin surface of the penis
* PeIN on the glans (head) or foreskin of the penis is also called erythroplasia of Queyrat
* PeIN on the shaft of the penis is also called Bowen’s disease
* 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
* A slow-growing, locally destructive verrucous plaque
* Cauliflower-like mass
* A regional variant of verrucous carcinoma, also known as giant condyloma acuminate
* Can involve the penis, vulva, scrotum, bladder, and perianal or anorectal regions
* Rare
* Bowen's Disease
* Undifferentiated PeIN
* Manifests as a solitary, pigmented, scaly or scab-covered area
* Affects the penis shaft, scrotum, perineum, and the suprapubic area
* 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)
* Erythroplasia of Queyrat
* Grows on the glans and the prepuce
* Presents as a well-defined, red patch
* Undifferentiated PeIN

## References

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1. ↑ Precancerous conditions of the penis. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/penile/penile-cancer/precancerous-conditions/?region=ab Accessed on September, 30 2015
2. ↑ Differential diagnoses of penile cancer. Oncology Encyclopedia 2015.http://oncolex.org/penile-cancer/background/differentialdiagnoses Accessed on September, 30 2015
3. ↑ "Differential diagnoses of penile cancer".

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