ABSTRACT BACKROUND: Erythroplasia of Queyrat (ICD D 07.4) is a cancer of the skin of the glans penis and the inner layer of the foreskin. It is lassified as squamous cell carcinoma in situ. However, current literature lacks data on the prevalence of this disease in various age groups. AIM: To study the clinical and epidemiological aspects of erythroplasia of Queyrat and evaluate the effectiveness of various diagnostic methods. METHODS: A retrospective observational study of 327 case histories of patients who sought medical help for penile lesions of various origins was conducted, and 49 patients with erythroplasia of Queyrat (EC) were observed. In the diagnosis of EC, the following were used: staining with toluidine blue, dermatoscopy, cytological and histological examinations, additionally an ultrasound examination (US) of the penis and inguinal lymph nodes, an examination for sexually transmitted infections and a transrectal ultrasound examination (TRUS) of the prostate gland were performed. RESULTS: Observation of 49 patients with EC revealed a clear rejuvenation: in those under 29 years of age, the disease is diagnosed in 12.24%, and in those 30-39 years of age - 20.4%.The largest proportion (30.61%) were aged 50-59 years, and the age group 60-79 years accounted for 18.36% of patients. Patient behavior upon detection of penile rashes: 89.8% of patients consulted doctors of various specialties (urologist, dermatovenerologist, oncologist, etc.), and 10.2% self-medicated. The timing of patients' visits to specialists after penile rashes is also alarming: 4.0% of patients visited a doctor within 1 week, 83.6% after 1 month, 8.1% after 1 year to 5 years, and 2.0% after more than 5 years; 2% of patients could not indicate the duration of the disease. Thus, patients with a disease history of 1 year or more (12.1%) can be considered at the highest risk of developing squamous cell carcinoma of the penis (Penile SCC). The final diagnosis of Penile SCC was made by a dermatovenerologist during the initial or follow-up visit (93.87%), by an oncologist during the initial visit (4.08%), and by a urologist during the initial or follow-up visit (2.04%). Thus, we see the importance of knowledge of the clinical picture and diagnostic methods by dermatovenerologists, since the majority of patients with EC turn to these specialists. CONCLUSION: We have filled the gap in the modern assessment of clinical and epidemiological aspects and the effectiveness of diagnostics in patients with erythroplasia of Queyrat. The study's results will help expand knowledge about the clinical and epidemiological aspects of the disease and the value of diagnostic methods, which will facilitate the selection of effective diagnostics and the development of treatment methods for EC. Keywords: erythroplasia of Queyrat; dermatoscopy, toluidine blue, cytological and histological examination.

Abstract Introduction: Genital mucosal lesions encompass a diverse spectrum of infectious, inflammatory, and neoplastic conditions and go beyond sexually transmitted infections. Accurate clinical diagnosis can be challenging due to anatomical location, overlapping presentations, and secondary changes. Histopathological examination remains a crucial tool to establish the definitive diagnosis and guide management. Aim: To study the clinical patterns of genital mucosal lesions other than STIs and analyse the correlation between clinical diagnosis and histopathological findings. Settings and Design: Cross sectional study; Department of Dermatology in a tertiary care teaching hospital. Subjects and Methods: A prospective cross-sectional study was conducted from July 2022 to January 2024 at a tertiary care hospital. A total of 27 patients presenting with genital mucosal lesions were included. Detailed history, clinical examination, and biopsy of the lesions were performed. Clinical and histopathological diagnoses were compared to assess correlation. Results: Among the 27 patients, males were more frequently affected (63%) than females (37%), with the most common age group being 31–40 years (33.3%). The most frequently observed clinical diagnoses included genital lichen planus (LP) (25.9%), LSCA (14.8%), and squamous cell carcinoma (SCC) (14.8%). Clinicopathological concordance was observed in 66.7% of cases. The highest correlation was seen in inflammatory disorders such as LP and lichen sclerosus, while lower correlation was noted in premalignant and malignant lesions including SCC and erythroplasia of Queyrat. Conclusions: A moderate clinicopathological correlation was observed in genital mucosal lesions, particularly among inflammatory dermatoses. Biopsy remains essential in confirming diagnosis and identifying cases with atypical or misleading features.

Erythroplasia of Queyrat (EQ), an in situ squamous cell carcinoma, is often treated with photodynamic therapy (PDT). In this case, reflectance confocal microscopy (RCM) was used for the diagnosis and monitoring of treatment efficacy in a 35-year-old man. RCM provided real-time high-resolution imaging of the lesion’s progression through PDT, helping to track therapeutic response and recurrence. This case highlights the value of RCM in the diagnosis and follow-up of EQ, offering insights into future clinical applications for skin cancer management.

Rationale:This case of Erythroplasia of Queyrat (EQ) in a 52-year-old male, driven by high-risk human papillomavirus (HPV)-18, is notable for progressing to carcinoma in situ despite photodynamic therapy (PDT). It highlights PDT’s limitations in HPV-positive EQ, emphasizing HPV genotyping and aggressive initial therapies to prevent malignancy.Patient Concerns:The patient had a persistent, erythematous, velvety plaque on the glans penis with mild pruritus. Examination showed a well-demarcated lesion.Diagnoses:Biopsy confirmed dysplastic squamous epithelium. Molecular testing identified HPV-18, indicating high malignant potential, leading to a diagnosis of EQ.Interventions:The patient received PDT, followed by conservative treatments including topical therapies upon recurrence.Outcomes:PDT achieved partial lesion regression, but recurrence as carcinoma in situ was confirmed histologically. Conservative treatments failed to stop progression, with HPV-18 driving the aggressive course, necessitating escalated interventions.Lessons:HPV genotyping is vital to identify high-risk subtypes like HPV-18; PDT may be inadequate for HPV-positive EQ, requiring aggressive therapies; rigorous long-term surveillance is essential to prevent squamous cell carcinoma progression.

Oncological diseases of the anogenital zone in men have become increasingly relevant in recent years. It is associated with the increasing incidence, subtle clinical manifestations, and difficulties in establishing a diagnosis, requiring, in most cases, histological examination, since the diagnostic capabilities of non-invasive methods, unfortunately, are limited. Precancerous conditions, both associated with the human papillomavirus (HPV) and HPV-negative, occupy a special place among penile oncological disorders, timely diagnosis of which is extremely important. To determine the frequency of precancerous and malignant diseases of the penis in the general structure of anogenital dermatoses in men, as well as to describe their main clinical features. The results of a survey of 160 men aged 18 to 86 years with various dermatoses of the anogenital zone who seek medical help in dermatological or urological departments are presented in the article. Various forms of penile squamous cell carcinoma were detected in 17 (10.6%), and precancerous conditions were detected in 21 (13.1%) cases. Among the latter, HPV-associated subtype of penile intraepithelial neoplasia (bowenoid papulosis, Bowen's disease, erythroplasia of Queyrat) was diagnosed in 19 (11.8%) patients. Objective symptoms were characterized by a variety of morphological and clinical manifestations. The list of incorrect clinical diagnoses which patients are followed with included banal balanoposthitis, lichen sclerosis, psoriasis, lichen planus, leukoplakia, and papillomatous nevus, which are characterized by a recurrent course and low efficiency of therapy. Histological examination was required to confirm the diagnosis of squamous cell carcinoma and precancerous diseases. The oncological alertness of urologists and dermatologists in patients with chronic recurrent processes of the external genitalia is justified. If there is any doubt, tissue biopsy for morphological diagnostics should be done.

Cutaneous squamous cell carcinoma (cSCC) is the second-most-prevalent malignancy in humans. A delayed diagnosis of cSCC leads to heightened invasiveness and positive surgical margins. Bowen's disease (BD) represents an early form of cSCC and presents as a small erythematous, photo-distributed, psoriasiform plaque. Although certain dermoscopy features in BD are quite characteristic, histopathology remains the gold standard for diagnosis and provides a severity-scoring system that assists in guiding appropriate treatment strategies. The classification of precancerous lesions of the vulva and penis has undergone multifarious transformations due to variations in clinical and histopathological characteristics. Presently, erythroplasia of Queyrat is categorized as a clinical variant of penile intraepithelial neoplasia (PeIN). The diagnoses of vulvar intraepithelial neoplasia (VIN) and PeIN present significant challenges and typically necessitate one or more biopsies, potentially guided by dermoscopy. Aceto-white testing demonstrates a notably high negative predictive value for genital precancerous lesions. Histopathological examination represents the gold-standard diagnosis in VIN and PeIN, while p16 and p53 immunostainings alongside HPV testing provide crucial diagnostic clues. The histopathologic features, degree of differentiation, and associations with lichen planus, lichen sclerosus, and HPV guide the selection of conservative treatments or surgical excision.

Over the few last decades, dermoscopy has become an invaluable and popular imaging technique that complements the diagnostic armamentarium of dermatologists, being employed for both tumors and inflammatory diseases. Whereas distinction between neoplastic and inflammatory lesions is often straightforward based on clinical data, there are some scenarios that may be troublesome, e.g., solitary inflammatory lesions or tumors superimposed to a widespread inflammatory condition that may share macroscopic morphological findings. We reviewed the literature to identify dermoscopic clues to support the differential diagnosis of clinically similar inflammatory and neoplastic skin lesions, also providing the histological background of such dermoscopic points of differentiation. Dermoscopic differentiating features were identified for 12 relatively common challenging scenarios, including Bowen's disease and basal cell carcinoma vs. psoriasis and dermatitis, erythroplasia of Queyrat vs. inflammatory balanitis, mammary and extramammary Paget's disease vs. inflammatory mimickers, actinic keratoses vs. discoid lupus erythematosus, squamous cell carcinoma vs. hypertrophic lichen planus and lichen simplex chronicus, actinic cheilitis vs. inflammatory cheilitis, keratoacanthomas vs. prurigo nodularis, nodular lymphomas vs. pseudolymphomas and inflammatory mimickers, mycosis fungoides vs. parapsoriasis and inflammatory mimickers, angiosarcoma vs granuloma faciale, and Kaposi sarcoma vs pseudo-Kaposi. Dermoscopy may be of aid in differentiating clinically similar inflammatory and neoplastic skin lesions.

Syphilitic balanitis, or Follmann’s balanoposthitis, is an atypical form of primary syphilis that can mimic various diseases of the male genitourinary system. Prompt diagnosis is crucial to avoid treatment complications. The aim of the study is understanding the peculiarities of the differential diagnosis of Follmann’s syphilitic balanoposthitis. Materials and methods. The clinical presentation of syphilitic balanoposthitis of Follmann varies from erosive lesions to dense infiltration and erythematous spots. Patients complain of painful erosions and swelling of the glans penis, with regional lymphadenitis commonly observed. Differential diagnosis includes excluding other infections, such as herpes, candidiasis, allergic dermatitis, and erythroplasia of Queyrat. Laboratory diagnostics involve direct methods for detecting T. pallidum and serological tests. Treatment involves the use of benzathine benzylpenicillin or alternatives, such as doxycycline, in cases of penicillin allergy. Results. Clinical case was analyzed, features of the course, diagnostic difficulties, and treatment results were determined. Conclusions. Clinical case highlights the importance of thorough examination in detecting infection sources, especially in atypical primary syphilis with Follmann’s balanoposthitis. Due to the possible seronegative phase, a comprehensive differential diagnosis is vital to prevent misdiagnosis. Accurate diagnosis and effective treatment require detailed anamnesis, clinical examination, and appropriate serological and bacteriological tests.

Basal cell carcinoma (BCC) is the most common primary carcinoma of skin, which accounts for three-fourth of all primary skin tumours. Basal carcinoma occurs commonly as a single lesion, though occasionally it can occur as Multiple lesions, which may occur in close association with heredofamilial conditions such as nevoid basal cell carcinoma syndrome (Gorlin’s syndrome), Bazex syndrome, Rombo syndrome, and unilateral basal cell nevus syndrome. The case of multiple basal cell carcinomas being presented here is unique in its occurrence inasmuch as it is not associated with heredofamilial conditions, and despite not being associated with heredofamilial conditions there is occurrence of multiple basal carcinomas in a patient in a tertiary care hospital in a dominantly tribal region. The patient has no family history of genodermatosis that could increase the incidence of multiple basal cell carcinomas such as xeroderma pigmentosum, and no history of other predisposing conditions including actinic keratosis, Bowen’s Disease, leukoplakia, Erythroplasia of Queyrat, keratoacanthoma, radiation dermatitis and exposure to arsenicals, psoralen and other photosensitizing medications. However, the patient had history of having raised macules over the face which were diagnosed as seborrheic keratosis.

Anogenital warts are caused by the human papillomavirus (most commonly types 6 and 11, giant condylomas ― types 16 and 18) and are exophytic and endophytic growths on the skin and mucous membranes of the genital and perianal areas. There is no generally accepted classification, but based on clinical manifestations, there are: acute condylomas, papular, patchy, hyperkeratotic, and giant condyloma acuminatum (BuschkeLowenstein tumor). Anogenital warts can be the result of infection through sexual contact, which is indicated by the synonym venereal warts. Anogenital warts is a separate nosology (International Classification of Diseases of the Tenth Revision: A63.0), but can also be part of the symptom complex of immunodeficiency conditions (in particular acquired immunodeficiency syndrome) and neoplasias (squamous cell carcinoma and erythroplasia of Queyrat).
 We offer the publication of a photogallery on this problem.

Background Erythroplasia of Queyrat (EQ) is a rare squamous cell carcinoma in situ, usually occurring on the glans penis, the prepuce, or the urethral meatus. Therapy is mandatory because it can progress to invasive carcinoma in up to 30% of cases. Treatment options include 5-fluorouracil, curettage, cryotherapy, radiotherapy, laser, partial or total penectomy, and micro surgery, as also with imiquimod and photodynamic therapies. Methods Between 2015 to 2018 we treated five patients, with histologically confirmed EQ, with ingenol mebutate (IM) 0.015% gel applied for 3 days consecutively. Results Three patients showed complete response at one year follow up. Two patients showed partial response after two months so they received a second course of therapy with IM. At one year follow up, one of them showed complete response, the other partial response. Conclusions Our experience demonstrated that IM may be considered as an effective and safe treatment option in EQ. IM offers various advantages such as easy and fast application, rapid complete remission, better compliance, few side effects and excellent cosmetical results. The authors call for further exploitation in bigger trials.

The pathogenesis of penile intraepithelial neoplasia (PeIN) is unclear but human papillomavirus (HPV) infection and polymorphisms in human leucocyte antigen (HLA). To examine the prevalence of HPV DNA and HLA in PeIN. Adult Caucasian men with a clinical and histological diagnosis of PeIN, that is, Bowenoid papulosis (BP), Bowen's disease of penis (BDP) and erythroplasia of Queyrat (EQ) were selected and phenotyped from the clinical records. DNA was extracted from blood and paraffin-embedded sections for HLA and HPV typing, respectively. Human leucocyte antigen allele frequencies were compared with those derived from the UK-based Caucasian population. Seventy-two cases of PeIN (20 BP, 34 BDP and 18 EQ) were studied. Human papillomavirus DNA was identified in 65/72 (90.2%) PeIN; Alphapapillomavirus types were detected in 62/72 (85%) followed by Betapapillomavirus types in 9/72 (12.5%) and cutaneous types in 7/72 (9.7%); HPV16 was the most prevalent genotype at 35/72 (48.6%) followed by HPV33 at 7/72 (9.7%); multiple infections were seen in 18/72 (25%) PeIN. HLA-C*15 (Bonferroni corrected p = 0.049) confers susceptibility to PeIN, whereas HLA-DQA1*01 (corrected p = 0.02) protects against PeIN. HPV16-associated PeIN cases showed no statistically significant association with HLA genotype after multiple corrections. Human papillomavirus is involved in the pathogenesis of PeIN. Immunogenotype may play a role in the pathogenesis of PeIN.

Bowen’s disease also known as squamous cell carcinoma in situ, a rare form of progressive, intraepidermal carcinoma, first described by John T. Bowen in 1912.We report a case of 62-year-old elderly male, retired teacher who presented with history of gradually expanding, asymptomatic, Pinkish-reddish raised lesion present on right thigh and left lumbar region since five years. Examination revealed sharply-demarcated, slightly elevated, erythematous, scaly and crusted plaque with dry and rough surface. Histological examination showed Hyperkeratosis, parakeratosis, with moderate lymphocytic infilterate in upper dermis. There was full Thickness anaplasia of the epidermis and atypical keratinocytes which are disorderly arranged. Keywords: Squamous cell carcinoma in situ, Erythroplasia of Queyrat, Solar damage, Arsenic, Cauasian.

This paper presents the current data regarding the epidemiology, risk factors, diagnosis, clinical manifestations, and treatment of Erythroplasia of Queyrat (EQ). The possibility of using photodynamic therapy (PDT) for EQ is analyzed, and clinical observation of a patient with EQ who underwent PDT with an external gel photosensitizer based on E6 chloride is described.

Erythroplasia of Queyrat (EQ) is an intraepidermal carcinoma in situ presenting clinically as a sharply demarcated, slightly raised erythematosus plaque on the glans penis or the inner side of the foreskin. Various treatment modalities for EQ have been proposed, including electrocautery and curettage, topical 5-floururacil cream, imiquimod cream, isotretinoin, cryotherapy, laser therapy, radiotherapy, ingenol mebutate gel and Photodynamic Therapy (PDT). Most of these treatments are limited by low clearance rates and frequent relapses. Surgical treatment including local excision, Mohs micrographic surgery and partial or total penectomy, ensures adequate healing rates. However, discomfort consequent to surgical treatment might be unacceptable. Topical PDT using the methyl ester of 5- aminolaevulinic acid (MAL) is an established non-surgical treatment of cutaneous precancerous lesions and skin cancers. We present the case of a 60-year-old uncircumcised man affected by EQ of the penis successfully treated with MAL-PDT, performed five times, two weeks apart, with no recurrences after 6 years.

147 The expression of 5-hydroxymethylcytosine, TET2 and retinoid acid receptor-β in male genital diseases

The review is dedicated to the analysis of the effectiveness of the treatment of erythroplasia of Queyrat (EQ) using photodynamic therapy (PDT). Particular attention is paid to the relationship between EQ and human papillomavirus (HPV) infection. The data of various researchers are presented, confirming the correlation between the development of the EQ and the HPV infection, however, it is noted that due to the small number of studies it is difficult to draw reliable conclusions on the presence and strength of this connection. The mechanisms of PDT involved in the implementation of both the antitumor effect in the treatment of EQ and the antiviral effect against HPV are considered. The data of 12 clinical studies and observations of the results of PDT of the EQ conducted in recent years are analyzed. An analysis of literature data showed that in the treatment of EQ, one of the two photosensitizers is usually used locally: 5-aminolevulinic acid or 5-aminolevulinic acid methyl ester. The treatment parameters in all the analyzed studies were similar: exposure to the ointment for 3–5 hours followed by irradiation with a light dose of 37–105 J/cm 2 . The number of PDT courses in different studies varied from 1 to 19. The effectiveness of treatment varied widely in different studies and clinical observations. Most studies have demonstrated high efficacy of PDT with complete regression in 36–83% (100% in one study) and a relapse-free follow-up period of up to 51 months. However, there were also individual clinical observations of patients in whom the treatment with the method of PDT was ineffective. It is possible that the described results were associated with improperly selected regimes of PDT or a large lesion area. Most authors especially note a very good cosmetic effect and a complete absence of scars after the treatment. Thus, PDT is an effective and promising method for the treatment of EQ that requires, however, a more thorough development of the application regimen and a deeper study of the antitumor and antiviral components of the mechanism of action.

Erythroplasia of Queyrat (EQ) is a rare squamous cell carcinoma in situ, usually occurring on the glans penis, the prepuce, or the urethral meatus. Therapy is mandatory because it can progress to invasive carcinoma in up to 30% of cases. Treatment options include 5-fluorouracil, curettage, cryotherapy, radiotherapy, laser, partial or total penectomy, and microsurgery, as also with imiquimod and photodynamic therapies. Between 2015 to 2018 we treated five patients, with histologically confirmed EQ, with ingenol mebutate (IM) 0.015% gel applied for 3 days consecutively. Three patients showed complete response at one year follow up. Two patients showed partial response after two months, so they received a second course of therapy with IM. At one-year follow-up, one of them showed complete response, the other partial response. Our experience demonstrated that IM may be considered as an effective and safe treatment option in EQ. IM offers various advantages such as easy and fast application, rapid complete remission, better compliance, few side effects and excellent cosmetical results. The authors call for further exploitation in bigger trials.

Introduction: Non-venereal genital dermatoses tend to be confused with venereal diseases, which cause concern to patients and diagnostic dilemma to physicians. A comprehensive understanding of their pattern of presentation, etiology and treatment options is therefore essential to effectively manage the condition and also allay the associated anxiety. This study was to determine the clinico- etiological and epidemiological pattern of presentation of non-venereal dermatoses in male genitalia; Materials and Methods: This was a hospital based descriptive study of 200 male patients over the age of 18years with non-venereal dermatoses of external genitalia attending DVL OPD of KIMS, Amalapuram. Patients having any venereal disease were excluded. A detailed history was taken and a thorough examination of the genitalia, skin and mucosae was done. Gram’s stain, KOH mount, Tzanck smear, patch test, skin biopsy were done as and when required to establish the diagnosis. Results: The overall prevalence of non-venereal genital dermatoses during the study period was 30.8 per 10,000 male patients. A total of 28 different conditions were identified of which the most common was scabies which accounted for 38% followed by candidiasis and vitiligo 12% each, pearly penile papules (10.5%). Certain interesting cases like verrucous carcinoma, lupus valgaris, Behcet’s disease, Erythroplasia of Queyrat, Lymphangiectasia with ramhorn penis and Acrochordon over prepuce were encountered. The data was tabulated and analysed using SPSS version22. Conclusion: Knowledge about the prevalence, etiology of various non- venereal genital dermatoses will be helpful to arrive at adiagnosis and create awareness among patients. Keywords: Non-venereal dermatoses, Male genitalia, Pattern.

The clinical diagnosis of penile intraepithelial neoplasia is challenging. No specific dermoscopic criteria for penile intraepithelial neoplasia have been described in the literature. This study aimed to describe and evaluate the dermoscopic features of penile intraepithelial neoplasia. Clinical and dermoscopic images of 11patients with histopathologically confirmed penileintraepithelial neoplasia were recorded and evaluated. The most frequent dermoscopic features were the presence of structureless areas (100%, structureless pink 72.7%) and vascular structures (81.8%), particularly dotted vessels (72.7%). Other findings included the absence of a pigment network (100%); scale (45.5%); scar-like areas (45.5%); erosions (27.3%); and pigmentation consisting of brown-grey dots and globules (27.3%). The dermoscopic features that characterise penile intraepithelial neoplasia are structureless pink areas and a prominent vascular pattern (mainly clustered dotted vessels). Dermoscopy is a useful tool that can aid in the diagnosis and surveillance of penile intraepithelial neoplasia.