3. Introduction
• A morphologically altered tissue in which cancer
is more likely to occur than in its apparently
normal counterpart 1
• 42% with preexisting lesions 2
1 World Health Organization. Geneva: World Health
Organization 1973
2 Bouchet et al, 1989
4. Types
• Carcinoma in situ (CIS)
• New classification 1
▫ Human papilloma virus (HPV) related penile
premalignant lesions
▫ Non – HPV related penile premalignant lesions
1 Shabbir et al, 2011b
5. Penile Intrepithelial Neoplasia (PIN)
• Queyrat -1911
• Types 1:
1. Erythroplasia of Queyrat (EQ)
2. Bowen disease (BD)
3. Bowenoid papulosis (BP)
1 Potter et al, 2002
6. Erythroplasia of Queyrat (EQ)
• Lesion 1:
▫ Glans or prepuce
▫ Red, velvety lesions, ulcerations
• Discharge and pain
• Progression to invasive carcinoma: 10 - 33% 2
1 Arogana et al, 1985
2 Bleeker et al, 2009
7. Bowen Disease (BD)
• Lesion 1:
▫ Penile shaft or remainder
▫ Sharply defined plaques of scaly erythema
▫ Crusted or ulcerated variants
• Progression to invasive carcinoma: 5% 2
1 Graham and Welwig, 1973
2 Buechner, 2002
8. Microscopic findings of CIS 1
• Atypical hyperplastic cells
• Extension of rete pegs
• Capillary proliferation and ectasia with
surrounding inflammatory infiltrate
1 Buechner, 2002
9. Management
• Biopsy – multiple
• Treatment:
▫ Circumcision 1
▫ Glans resurfacing 2
• Alternative strategies 3:
• 5 FU cream
• 5% imiquimod cream
• Laser therapy:
Nd: YAG, KTP, CO2
1 Bissada, 1992
2 Hadway et al, 2006
3 Danielson et al, 2003
10. Bowenoid Papulosis (BP)
• Lesion 1:
▫ Multiple papules or pigmented lesions
▫ Penile shaft or glans
• Second or third decade 1
• HPV 16 linkage 2
• Invariably benign 3
1 Patterson et al, 1986
2 Endo et al, 2003
3 Su and Shipley, 1997
11. Treatment of BP 1
• Electrodessication
• Cryotherapy
• Laser fulguration
• Topical 5 FU cream
• Excision 1 Campbell 12th edition
12. Non HPV penile premalignant lesions
1. Cutaneous horn
2. Pseudoepitheliomatous keratotic and
micaceous balanitis (PKMB)
3. Male lichen sclerosus