Dermal Graft Repair of Peyronie’s Disease Complicated by Epidermoid Cyst

Abstract

A 46-year-old male presented with a history of progressive unilateral penile girth expansion. The area was soft and painless, and the degree of enlargement was unrelated to penile erections. Surgical history was significant for a dermal graft procedure performed elsewhere 2 years previously for erectile curvature due to Peyronie’s disease. The operative note described use of a dermal graft without detailing its harvest and preparation. Physical examination demonstrated a 5 6 cm. lateral penile mass that was soft and nontender (fig. 1, A). Magnetic resonance imaging (MRI) revealed a well-defined mass with high intensity signal on T2-weighted imaging and no contrast enhancement (fig. 2). On penile exploration a keratin filled mass with intermingled hair was found (fig. 1, B). Subsequently the keratin was removed and an epidermal layer was identified at the base of the lesion. The epidermis was sharply removed from the underlying dermis. Artificial erection confirmed that the graft was still intact, and the degloved penile skin was then approximated to the mucosal skirt. Two months later the patient had an excellent cosmetic result and denied any change in erectile function.