A case of pigmented penile intraepithelial neoplasia: Dermoscopic and clinicohistopathologic analysis Ben J. Friedman, MD, and Laurie L. Kohen, MD Detroit, Michigan
CLINICAL PRESENTATION A 79-year-old uncircumcised Caucasian male presented to the dermatology clinic complaining of a sensitive rash on his prepuce. Examination revealed an eroded plaque on the dorsum of the prepuce. More proximally, there was an irregular dark blue-black patch with asymmetry and scalloped borders. These changes were observed on a background of erythema (Fig 1).
Fig 1. Penile intraepithelial neoplasia. Clinical photo demonstrating erosion, irregular hyperpigmentation, and erythema on the dorsal prepuce.
DERMOSCOPIC APPEARANCE Polarized dermoscopic examination of the erosion revealed a central orange crust surrounded by an array of variably sized glomeruloid vessels, along with a few scattered twisted-loop hairpin vessels (Fig 2, A). Examination of the pigmented portion of the lesion revealed a large blue-black structureless area, gray granules, brown dots, and diffuse, scattered glomeruloid vessels (Fig 2, B).
From the Department of Dermatology, Henry Ford Hospital, Detroit, MI. Publication of this article was supported by 3Gen. Funding sources: None. Conflicts of interest: None declared. Reprint requests: Ben J. Friedman, MD, Henry Ford Hospital, Department of Dermatology, 3031 W Grand Blvd, 8th floor, Detroit, MI 48202. E-mail: [email protected].
J Am Acad Dermatol 2015;72:S71-2. 0190-9622/$36.00 ª 2014 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2014.09.039
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S72 Friedman and Kohen
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Fig 2. Penile intraepithelial neoplasia. Dermoscopy of the eroded plaque (A) and hyperpigmented patch (B) shown in Fig 1. Note the numerous scattered glomerular vessels (black arrows), gray granules (white arrows), and the blue-black structureless area (pentagon).
HISTOLOGIC DIAGNOSIS Histopathologic examination revealed full-thickness keratinocyte atypia, focal erosion, and occasional mitoses and dyskeratotic keratinocytes. Dense lymphocytic inflammation, dermal melanophages, and few scattered suprabasal dendritic melanocytes were seen in the heavily pigmented portion of the lesion (Fig 3). Immunohistochemical staining was positive for high-molecular-weight keratin and negative for Cam 5.2 (neither shown). These features were most consistent with a diagnosis of dedifferentiated penile intraepithelial neoplasia (PIN).
Fig 3. Penile intraepithelial neoplasia. Histopathology: note the full-thickness keratinocyte atypia, focal erosion, dense lymphocytic inflammation, and presence of dermal melanophages. (Hematoxylin-eosin stain.)
KEY MESSAGE Pigmented PIN may share similar dermoscopic features with conventional pigmented Bowen disease.1 However, the scattered nature of glomeruloid vessels in this case differs from the typically grouped nature seen in conventional Bowen disease.2 Moreover, pigment in nonmucosal pigmented Bowen disease is typically seen in a linear arrangement at the periphery; perhaps the blue-black structureless area seen in this case was due to dense lymphocytic infiltrate intermixed with dermal melanophages.
REFERENCES 1. Ishioka P, Yamada S, Michalany NS, Hirata SH. Dermoscopy of Bowen’s disease: pigmented variant on the penis. An Bras Dermatol 2012;87:482-4. 2. Cameron A, Rosendahl C, Tschandl P, Riedl E, Kittler H. Dermoscopy of pigmented Bowen’s disease. J Am Acad Dermatol 2010;62: 597-604.
CLINICAL PRESENTATION A 79-year-old uncircumcised Caucasian male presented to the dermatology clinic complaining of a sensitive rash on his prepuce. Examination revealed an eroded plaque on the dorsum of the prepuce. More proximally, there was an irregular dark blue-black patch with asymmetry and scalloped borders. These changes were observed on a background of erythema (Fig 1).
Fig 1. Penile intraepithelial neoplasia. Clinical photo demonstrating erosion, irregular hyperpigmentation, and erythema on the dorsal prepuce.
DERMOSCOPIC APPEARANCE Polarized dermoscopic examination of the erosion revealed a central orange crust surrounded by an array of variably sized glomeruloid vessels, along with a few scattered twisted-loop hairpin vessels (Fig 2, A). Examination of the pigmented portion of the lesion revealed a large blue-black structureless area, gray granules, brown dots, and diffuse, scattered glomeruloid vessels (Fig 2, B).
From the Department of Dermatology, Henry Ford Hospital, Detroit, MI. Publication of this article was supported by 3Gen. Funding sources: None. Conflicts of interest: None declared. Reprint requests: Ben J. Friedman, MD, Henry Ford Hospital, Department of Dermatology, 3031 W Grand Blvd, 8th floor, Detroit, MI 48202. E-mail: [email protected].
J Am Acad Dermatol 2015;72:S71-2. 0190-9622/$36.00 ª 2014 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2014.09.039
S71
S72 Friedman and Kohen
J AM ACAD DERMATOL
JANUARY 2015
Fig 2. Penile intraepithelial neoplasia. Dermoscopy of the eroded plaque (A) and hyperpigmented patch (B) shown in Fig 1. Note the numerous scattered glomerular vessels (black arrows), gray granules (white arrows), and the blue-black structureless area (pentagon).
HISTOLOGIC DIAGNOSIS Histopathologic examination revealed full-thickness keratinocyte atypia, focal erosion, and occasional mitoses and dyskeratotic keratinocytes. Dense lymphocytic inflammation, dermal melanophages, and few scattered suprabasal dendritic melanocytes were seen in the heavily pigmented portion of the lesion (Fig 3). Immunohistochemical staining was positive for high-molecular-weight keratin and negative for Cam 5.2 (neither shown). These features were most consistent with a diagnosis of dedifferentiated penile intraepithelial neoplasia (PIN).
Fig 3. Penile intraepithelial neoplasia. Histopathology: note the full-thickness keratinocyte atypia, focal erosion, dense lymphocytic inflammation, and presence of dermal melanophages. (Hematoxylin-eosin stain.)
KEY MESSAGE Pigmented PIN may share similar dermoscopic features with conventional pigmented Bowen disease.1 However, the scattered nature of glomeruloid vessels in this case differs from the typically grouped nature seen in conventional Bowen disease.2 Moreover, pigment in nonmucosal pigmented Bowen disease is typically seen in a linear arrangement at the periphery; perhaps the blue-black structureless area seen in this case was due to dense lymphocytic infiltrate intermixed with dermal melanophages.
REFERENCES 1. Ishioka P, Yamada S, Michalany NS, Hirata SH. Dermoscopy of Bowen’s disease: pigmented variant on the penis. An Bras Dermatol 2012;87:482-4. 2. Cameron A, Rosendahl C, Tschandl P, Riedl E, Kittler H. Dermoscopy of pigmented Bowen’s disease. J Am Acad Dermatol 2010;62: 597-604.
