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Pseudoepitheliomatous keratotic and micaceous balanitis
Other Resources UpToDate PubMed

Pseudoepitheliomatous keratotic and micaceous balanitis

Contributors: Katherine L. Boss Heckathorn MPH, Anna Marzvanyan DO, Susan Burgin MD
Other Resources UpToDate PubMed


Pseudoepitheliomatous keratotic and micaceous balanitis (PKMB) is an extremely rarely reported condition of the glans penis characterized by one or more slow-growing, white hyperkeratotic plaques, typically in older circumcised men. PKMB can also affect uncircumcised men. It has not been recorded in men younger than 30 years.

The pathogenesis of PKMB is unknown, but it may be a response to chronic inflammation or infection. Some studies implicate prior phimosis or untreated lichen sclerosus, although the data is insufficient.

Around half of patients are asymptomatic. Symptomatic patients may experience pain or soreness, itching, irritation, urinary symptoms, or sexual dysfunction. Symptom duration varies greatly (2 months to 30 years) and has not been found to be associated with stage at initial presentation or disease severity. The presence of inguinal lymphadenopathy has not been reported and should indicate a diagnosis other than PKMB.

PKMB may progress to verrucous carcinoma or squamous cell carcinoma (SCC) if untreated. Historically, 50% of patients presenting at an initial or late tumor stage progressed to verrucous carcinoma, SCC, or Bowen disease (squamous cell carcinoma in situ). PKMB is reported to appear as an initial plaque stage then thicken (late tumor stage) before progression to the verrucous stage (verrucous carcinoma) and SCC.


N48.1 – Balanitis

403466004 – Micaceous and keratotic balanitis

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Differential Diagnosis & Pitfalls

  • Verrucous carcinoma can be distinguished by minimal to no cellular atypia or mitotic figures compared to SCC and with characteristic epidermal hyperplasia with papillomatosis and an exophytic and/or endophytic growth pattern.
  • Cutaneous squamous cell carcinoma can be differentiated by cellular atypia and mitotic activity on histopathology.
  • Lichen sclerosus
  • Lichen planus
  • Lichen simplex chronicus
  • Psoriasis
  • Erythroplasia of Queyrat – presents as an erythematous patch.
  • Verrucous Genital herpes simplex virus – commonly in immunocompromised and HIV-infected individuals.
  • Giant Genital wart
  • Genital Cutaneous tuberculosis
  • Hypertrophic Granuloma inguinale
  • Keratoacanthoma – history of rapid growth; characteristic histopathology.

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    Last Reviewed:08/27/2022
    Last Updated:09/07/2022
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    Pseudoepitheliomatous keratotic and micaceous balanitis
    A medical illustration showing key findings of Pseudoepitheliomatous keratotic and micaceous balanitis
    Copyright © 2024 VisualDx®. All rights reserved.