- Penile epithelial neoplasia (PeIN) / carcinoma in situ = Any level of intraepithelial squamous cell atypia and alteration in squamous cell maturation
- Erythroplasia of Queyrat – on glans / prepuce
- Bowen disease – on skin of shaft
- Above = progress to invasive SCC 10 – 33 % of cases
- Bowenoid papulosis – pigmented papules in younger men – more likely benign
- BXO / lichen sclerosis
- Cutaneous horn
- Bowenoid papulosis
Histology of PeIN/CIS – atypical hyperplastic mucosal cells, hyperchromatic nuclei, multilevel mitotic figures, elongated bulbous rete, angiogenesis of submucosa.
PeIN clinical features
Usually a reddened, raised area.
May also be scaly erythema, crusted or ulcerated variants, or velvety well marginated lesions.
Any persisting erythematous lesion or penile lesion should raise suspicion of PeIN.
Treatment options:
Adequate biopsy and histopathological confirmation to exclude invasion. Consider circumcision prior to any topical treatments.
- Primary excision with 5 mm margins
- Topical chemotherapeutic agents
- Glans resurfacing
- Laser ablation with CO2 or Nd:YAG laser
Topical treatment
5 fluorouracil cream 5 % (Efudix)
- Pyrimidine analogue which disrupts DNA synthesis
- Apply BD for 2 – 6 weeks, with gloved finger or wash hands straight after
- Will cause local inflammatory reaction
Imiquimod cream 5 % (Aldara)
- Immune modulator which triggers inflammatory reaction
- Can also by used for warts / condylomata. 3 x week for 4 – 16 weeks.
- Need to consider repeat biopsy after completion of topical treatment.