31. Verrucous porokeratosis of the foreskin

Abstract

Porokeratosis is an uncommon genodermatosis, manifest through abnormalities of epidermal maturation and keratinisation, which presents in a number of distinct clinical and pathological forms. Verrucous porokeratosis is a recently described and uncommon porokeratosis variant primarily reported to involve the gluteal cleft. This variant shows prominent digitate epidermal hyperplasia and confluence of cornoid lamellae, histopathological features which are not generally associated with other described forms of porokeratosis. We present the first case of verrucous porokeratosis described on the penis. Review of the patient’s history identified a lesion of verrucous porokeratosis of the buttock incorrectly diagnosed as verruca vulgaris 7 years previously before more widespread porokeratotic lesions were recognised. This case highlights that clinical and pathological familiarity with verrucous porokeratosis is critical to avoid misdiagnosis as a human papilloma virus induced lesion, an interpretation which may be associated with unnecessary social stigma in the genitogluteal region. Although development of squamous cell carcinoma has not been reported in verrucous porokeratosis to date, it is a well recognised complication of other forms of porokeratosis and clinical follow up would seem appropriate.