Diagnosis and clinical presentation of premalignant lesions of the penis

Although a considerable number of penile cancers may arise de novo, certain potentially premalignant conditions do exist. We account in some detail fo r precancerous growths, which may initially be misclassified and not submit ted to proper therapy and follow-up. At one end of the spectrum disorders e xist that are generally considered as medically benign, such as warty tumor s; at the other end growths occur that are highly indicative of being poten tially invasive, i.e. giant condylomas, bowenoid papulosis, eythroplasia of Queyrat and Bowen's disease. We also focus on elucidating the clinical beh avior of some inflammatory conditions, which may either be of pathogenic si gnificance for squamous cell carcinoma development or give rise to differen tial diagnostic problems, most importantly lichen sclerosus et atrophicus ( balanitis xerotica obliterans). We advocate a vigilant approach for histopa thological evaluation whenever any clinical diagnostic uncertainty or thera peutic recalcitrance exists. We also favor the administration of highly act ive topical therapy against penile chronic inflammatory conditions such as lichen sclerosus et atrophicus, careful clinical follow-up of these cases a nd surgical treatment of phimosis.