Pseudoepitheliomatous keratotic and micaceous balanitis
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
Differential Diagnosis & Pitfalls
- 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.
- can be differentiated by cellular atypia and mitotic activity on histopathology.
- – presents as an erythematous patch.
- Verrucous – commonly in immunocompromised and HIV-infected individuals.
- – history of rapid growth; characteristic histopathology.