Erythroplasia of Queyrat

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Swathi Venkatesan, M.B.B.S.[2]

Synonyms and keywords: EQ

Overview

Erythroplasia of Queyrat is a penile squamous cell carcinoma in situ named after Louis Queyrat, a French dermatologist who was head of the dermatology service of l'Hôpital Ricord, a venereal hospital in Paris, now Hôpital Cochin. The pathogenesis of Erythroplasia of Queyrat is characterized as a precancerous lesion of squamous cell carcinoma in situ of the glans penis and inner prepuce or foreskin. Erythroplasia of Queyrat is most commonly observed among white male patients aged 60 years old and older with Human Papilloma Virus (HPV) infection or chronic irritation and lack of hygiene of pubic area. The most common risk factor in the development of Erythroplasia of Queyrat is an uncircumcised penis. The mainstay of therapy for Erythroplasia of Queyrat is imiquimod or 5-fluorouracil for several weeks to months.

Historical Perspective

  • Erythroplasia of Queyrat was first discovered and named after Louis Queyrat.[1]
  • Louis Queyrat was French dermatologist who was head of the dermatology service of l'Hôpital Ricord, a venereal hospital in Paris, now Hôpital Cochin.
  • Tarnovsky originally described erythroplasia of Queyrat in 1891, but it was Queyrat who originated the term erythroplasia in 1911.

Classification

Jackson's Staging System for Squamous Cell Carcinoma of Penis

Stage Description
I Confined to glans of prepuce
II Invasion into shaft or corpora
III Operable inguinal lymph node metastasis
IV Tumor invades adjacent structures; inoperable inguinal lymph node metastasis

Pathophysiology

Histopathological Features

Clinical presentation of Erythroplasia of Queyrat Source: Department of Urology, Mid-Western Regional Hospital, Dooradoyle, Limerick, Co. Limerick, Ireland - National library of medicine

Causes

Besides old age and lack of circumcision, Erythroplasia of Queyrat has been linked to various factors including:

Differentiating Erythroplasia of Queyrat from Other Diseases

Erythroplasia of Queyrat must be differentiated from other diseases that cause Squamous cell carcinoma of penis. Differentials include:

Epidemiology and Demographics

Age

  • Erythroplasia of Queyrat is more commonly observed among patients aged 60 years old.

Gender

  • Males are affected with Erythroplasia of Queyrat.

Risk Factors

Most common risk factor in the development of Erythroplasia of Queyrat is uncircumcised penis. Other common risk factors in the development of Erythroplasia of Queyrat include:[8] [9]

Screening

There is insufficient evidence to recommend routine screening for Erythroplasia of Queyrat.[10]

Natural History, Complications, and Prognosis

If left untreated, patients with Erythroplasia of Queyrat may progress to develop invasive squamous cell carcinoma of the penis.[11] Because penile cancer is not common, it's hard to find accurate survival rates based on the TNM stage of the cancer. The numbers below come from the National Cancer Institute’s Surveillance Epidemiology & End Results (SEER) Program database, looking at more than 1,000 men diagnosed with penile cancer between 1988 and 2001.

Treatment in the early stages of penile cancer is critical for good long-term results and predominantly preserves quality of life by preserving normal sexual function.

Diagnosis

Diagnostic Study of Choice

Delays in the diagnosis and treatment of Erythroplasia of Queyrat are common because of two main factors.

Delay in diagnosis of more than 1 year has been observed in 15% to 20% of patients, the reasons usually being embarrassment, guilt, fear, personal neglect, or ignorance.

Symptoms

Penile Skin Changes

History and Symptoms

  • The hallmark of Erythroplasia of Queyrat is a red, velvety appearing rash beneath the penile foreskin."Precancerous conditions of the penis - Canadian Cancer Society".
  • The lesions are usually solitary and occasionally erode or ulcerate, but pain is uncommon.
  • A positive history of lack of circumcision and lesion growth are suggestive of Erythroplasia of Queyrat.
  • The most common symptoms of this precancerous condition include skin changes in the penile skin including color and thickness changes, chronic irritation , and lesion growth. Common symptoms of Erythroplasia of Queyrat include persistent, foul smelling discharge under foreskin, smegma, dysuria, weak urine stream, loss of sensation in glans, and inability to fully pull back foreskin over glans.

Physical Examination

Patients with Erythroplasia of Queyrat usually appear red, velvety appearing rash beneath the penile foreskin. Physical examination of patients with Erythroplasia of Queyrat is usually remarkable for penile skin changes including red, ulcerating, bleeding, and indurated lesion on the glans or red vegetating mass on the glans.

Laboratory Findings

There are no diagnostic laboratory findings associated with Erythroplasia of Queyrat.

Electrocardiogram

There are no ECG findings associated with Erythroplasia of Queyrat.

X-ray

There are no x-ray findings associated with Erythroplasia of Queyrat. However, if it has been proven cancer has spread to the lungs a chest x-ray might be done.

Echocardiography or Ultrasound

There are no ultrasound findings associated with Erythroplasia of Queyrat. However, an ultrasound may be helpful in the diagnosis of complications and to assess how deep the cancer has spread in the penis.

CT scan

There are no CT scan findings associated with Erythroplasia of Queyrat. However, a CT scan may be helpful in assessing the size of the precancerous lesion as well as to see if the cancer has spread to lymph nodes or other parts of the body.

CT-guided needle biopsy

CT scans can be used to guide a biopsy needle into an enlarged lymph node or other area that might be cancer spread.

MRI

There are no MRI findings associated with Erythroplasia of Queyrat. However, a MRI may be helpful in the diagnosis of complications of this precancerous lesion as well size and spread of the cancer if late initial diagnosis.

Other Imaging Findings

There are no other imaging findings associated with Erythroplasia of Queyrat.

Other Diagnostic Studies

There are no other diagnostic studies associated with Erythroplasia of Queyrat.

Treatment

Medical Therapy

Surgery

Surgery is the mainstay treatment of choice for Erythroplasia of Queyrat, and is often the only treatment needed for early stage penile cancers. Although, authors have used 5% 5-FU cream with some success.

Primary Prevention

There are no established measures for the primary prevention of Erythroplasia of Queyrat. However, researchers continue to look into various factors that may prevent this stage 0 cancer since there are no available vaccines against Erythroplasia of Queyrat. Effective measures for primary prevention include:

Secondary Prevention

There are no established measures for the secondary prevention of Erythroplasia of Queyrat.[11]

References

  1. Weidner, Noel (2009). Modern surgical pathology. Philadelphia, PA: Saunders/Elsevier. ISBN 9781437719581.
  2. 2.0 2.1 Hakenberg, Oliver W.; Compérat, Eva M.; Minhas, Suks; Necchi, Andrea; Protzel, Chris; Watkin, Nick (2015). "EAU Guidelines on Penile Cancer: 2014 Update". European Urology. 67 (1): 142–150. doi:10.1016/j.eururo.2014.10.017. ISSN 0302-2838.
  3. Lynch DF Jr. Cancer of the Penis. In: Kufe DW, Pollock RE, Weichselbaum RR, et al., editors. Holland-Frei Cancer Medicine. 6th edition. Hamilton (ON): BC Decker; 2003. Available from: https://www.ncbi.nlm.nih.gov/books/NBK13419/
  4. Marks, James G; Miller, Jeffery (2006). Lookingbill and Marks' Principles of Dermatology (4th ed.). Elsevier Inc. Page 63. ISBN 1-4160-3185-5.
  5. Clark PE, Spiess PE, Agarwal N, Biagioli MC, Eisenberger MA, Greenberg RE; et al. (2013). "Penile cancer: Clinical Practice Guidelines in Oncology". J Natl Compr Canc Netw. 11 (5): 594–615. PMC 4042432. PMID 23667209.
  6. Brady, Kimberly L.; Mercurio, Mary Gail; Brown, Marc D. (2013). "Malignant Tumors of the Penis". Dermatologic Surgery. 39 (4): 527–547. doi:10.1111/dsu.12029. ISSN 1076-0512.
  7. Bleeker MC, Heideman DA, Snijders PJ, Horenblas S, Dillner J, Meijer CJ (2009). "Penile cancer: epidemiology, pathogenesis and prevention". World J Urol. 27 (2): 141–50. doi:10.1007/s00345-008-0302-z. PMID 18607597.
  8. Bleeker, M. C. G.; Heideman, D. A. M.; Snijders, P. J. F.; Horenblas, S.; Dillner, J.; Meijer, C. J. L. M. (2008). "Penile cancer: epidemiology, pathogenesis and prevention". World Journal of Urology. 27 (2): 141–150. doi:10.1007/s00345-008-0302-z. ISSN 0724-4983.
  9. Douglawi, Antoin; Masterson, Timothy A. (2017). "Updates on the epidemiology and risk factors for penile cancer". Translational Andrology and Urology. 6 (5): 785–790. doi:10.21037/tau.2017.05.19. ISSN 2223-4683.
  10. Salami, Simpa S.; Montgomery, Jeffrey S. (2017). "Surveillance strategies in the management of penile cancer". Translational Andrology and Urology. 6 (5): 868–873. doi:10.21037/tau.2017.06.04. ISSN 2223-4683.
  11. 11.0 11.1 11.2 Schlenker, Boris; Schneede, Peter (2019). "The Role of Human Papilloma Virus in Penile Cancer Prevention and New Therapeutic Agents". European Urology Focus. 5 (1): 42–45. doi:10.1016/j.euf.2018.09.010. ISSN 2405-4569.
  12. Damjanov, Ivan (2009). "The Male Genital System": 329–338. doi:10.1016/B978-0-323-05594-9.00016-7.
  13. Choi, Jee Woong; Choi, Mira; Cho, Kwang Hyun (2009). "A Case of Erythroplasia of Queyrat Treated with Imiquimod 5% Cream and Excision". Annals of Dermatology. 21 (4): 419. doi:10.5021/ad.2009.21.4.419. ISSN 1013-9087.
  14. Antônio, João Roberto; Antônio, Carlos Roberto; Trídico, Lívia Arroyo; Alves, Fernanda Tomé; Rollemberg, Ivan (2016). "Erythroplasia of Queyrat treated with topical 5-fluorouracil". Anais Brasileiros de Dermatologia. 91 (5 suppl 1): 42–44. doi:10.1590/abd1806-4841.20164595. ISSN 0365-0596.