Pseudoepitheliomatous keratotic and micaceous balanitis

pseudoepitheliomatous,keratotic,and micaceous balanitis 1

Pseudoepitheliomatous keratotic and micaceous balanitis is a skin condition characterized by the presence of stratified and hyperkeratotic plaques resembling mica on the glans penis. ICD-10 Code: N48.8

The condition predominantly affects older males aged 50-70 years, often in those who have previously undergone circumcision for pre-existing phimosis. However, isolated cases have been reported in individuals aged 30-40 years. The prevalence is unknown as the condition is often undiagnosed.

The etiology and pathogenesis are not well understood. It has been suggested that the condition represents a form of pyoderma or a pseudoepitheliomatous response to various infections, including human papillomavirus (HPV) infection. Some authors consider the condition to be a variant of lichen sclerosus et atrophicus. Recently, the prevailing opinion has been that it is a precancerous condition, an intermediate stage between benign hyperplasia and carcinoma (verrucous or invasive squamous cell carcinoma) of the penis.

The condition is characterized by the appearance of painless hyperkeratotic plaques on the glans penis covered with thick, layered crusts that resemble mica, a mineral. The glans penis is typically dry and inelastic, and maceration, fissuring, and ulceration may be observed. If the plaques are localized near the urethral orifice, the "leakage symptom" may be observed, which involves the spraying of urine during urination.

The disease follows a chronic course with slow growth of the lesions. Metastasis is absent and regional lymph nodes are not enlarged. Cases of transformation to verrucous and invasive squamous cell carcinoma have been reported.

Diagnosis is based on clinical presentation and histologic examination showing hyperkeratosis, parakeratosis, acanthosis, pseudoepitheliomatous hyperplasia, and nonspecific dermal inflammatory infiltrates composed of lymphocytes, histiocytes, and plasma cells, occasionally with eosinophils.

  • Squamous cell carcinoma
  • Verrucous carcinoma
  • Cutaneous horn
  • Keratoacanthoma
  • Psoriasis
  • Buschke-Lowenstein giant condyloma
  • Erythroplasia of Queyrat

Treatment is based on the results of histologic examination. In the absence of atypia, treatment options may include the use of 5-fluorouracil cream, cryotherapy, or electrocautery. In cases suggesting malignancy, wide excision, partial or complete amputation of the penis may be necessary.