Disorders of the Genitalia, Perineum, and Anus Image

Pearly Penile Papules ICD-9: 607.89 ° ICD-10: N48.89 image

image Normal anatomic structures. Incidence: Up to 19%.

image Symptoms: Asymptomatic; may arouse some anxiety when first noted.

image Clinical findings: Skin-colored 1- to 2-mm, discrete, domed papules evenly distributed circumferentially around the corona (Fig. 34-1), giving a cobblestone pattern.

image Differential diagnosis: Condylomata acuminatum, molluscum contagiosum.

image Histology: Angiofibromas.

image Management: Reassurance: normal anatomic structures.

image Synonym: Angiofibromas.


Figure 34-1. Pearly penile papules Pink (skin-colored), 1- to 2-mm papules are seen regularly spaced along the corona of the glans penis. These structures, which are part of the normal anatomy of the glans, are commonly mistaken for condylomata or molluscum contagiosum.

Sebaceous Gland Prominence ICD-9: 789,9 ° ICD-10: Q89.9 image

image Normal sebaceous glands. Analogous to sebaceous gland on mucosa of mouth.

image Locations: Penis, vulva.

image Manifestation: 2-mm dermal papule; cream colored. May be arranged in rows.

image Synonyms: Tyson glands, sebaceous hyperplasia, “ectopic” sebaceous glands, Fordyce condition.

Angiokeratoma (See also Section 9) image

image Ectatic thin-walled blood vessels in the superficial dermis with overlying epidermal hyperplasia.

image Increasingly common with aging.

image Multiple purple, smooth, 2- to 5-mm papules. Bleed with trauma. (See Section 9, Fig. 9-25).

image Location: Scrotum, glans penis, penile shaft. Labia, vulva.

image Differentiate from angiokeratomas of Fabry disease (usually pinhead size, found on bathing trunk area and upper thighs), Kaposi sarcoma.

image Management: Reassurance, electrosurgery.

image Synonym: Angiokeratomas of Fordyce.

Sclerosing Lymphangitis of Penis ICD-9: 607.2 ° ICD-10: N48.29 image

image Etiology Trauma associated with vigorous sexual activity.

image Pathogenesis: Lymphatic stasis may result in thrombosed lymphatic vessels. Subsequent recanalization and fibrosis of walls of lymphatic vessels.

image Clinical findings: Painless, firm, at times nodular, translucent serpiginous cord appears suddenly,

image usually parallel to corona; not attached to overlying epidermis (Fig. 34-2).

image Course: Resolves spontaneously in weeks to months.

image Synonyms: Nonvenereal sclerosing lymphangitis, penile venereal edema, Mondor phlebitis.


Figure 34-2. Sclerosing lymphangitis: penis A dermal cord on the distal shaft parallel to the corona.

Lymphedema of the Genitalia ICD-9: 457.1 ° ICD-10: 189.0 image

image Acute idiopathic scrotal edema. Occurs in young boys. Resolves spontaneously in 1-4 days. Differentiate from acute scrotum. Also reported in adults with dengue hemorrhagic fever, Henoch-Schönlein purpura.

image Lymphogranuloma venereum (see Section 30). Occurs in chronic undiagnosed infection. Both sexes. Referred to as esthiomene: elephantiasis due to lymphatic obstruction. Chronic. Deformity of penis referred to as “saxophone penis.”

image Chronic recurrent bacterial infection may be causative (Fig. 34-3A, B).

image Kaposi sarcoma.

image Filarial or lymphatic elephantiasis. Caused by parasitic worms such as Wuchereria bancroftii, Brugia malayi, B. timori. Associated with elephantiasis of legs.

image Synonym: Lymphangiofibrosis thrombotica occlusiva.


Figure 34-3. (A, B) Chronic lymphedema: scrotum A 29-year-old male with history of recurrent scrotal infections that have destroyed lymphatic channels. There is scrotal noncompressible lymphedema and the penis is retracted.

Plasma Cell Balanitis and Vulvitis image

image Asymptomatic red glistening plaque(s) on glans penis (Fig. 34-4) or vulva.

image Differentiate from squamous cell carcinoma in situ.

image Management: Circumcision is curative in uncircumcised males. Otherwise, topical corticosteroids, calcineurin inhibitors, and imiquimod can be used. Electrosurgery and laser destruction have also been reported.

image Synonym: Zoon balanitis.


Figure 34-4. Plasma cell balanitis Solitary red glistening plaque for 10 years in an uncircumcised male.

Phimosis, Paraphimosis, Balanitis Xerotica Obliterans ICD-9: 607.81 ° ICD-10: N48.0 image

image Phimosis: nonretractable foreskin. Etiology: Lichen sclerosus, nonspecific balanoposthitis (posthitis is inflammation of foreskin or prepuce), lichen planus, cicatricial pemphigoid, chronic lymphedema, Kaposi sarcoma. Precludes examination of glans for precancerous changes (Fig. 34-5).

image Balanitis xerotica obliterans (BXO): End stage of chronic phimosis. Foreskin fibrotic, contracted, fixed over glans and cannot be retracted over glans. Most often end-stage lichen sclerosus, which is commonly referred to as BXO (see Section 14, lichen sclorosus).

image Paraphimosis: Foreskin fixed in retraction. Etiology: vigorous sexual activity, acute contact urticaria, acute allergic contact dermatitis, lichen sclerosus (Fig. 34-6).


Figure 34-5. Phimosis The prepuce or foreskin has been chronically inflamed with scarring and is no longer retractable over the glans penis.


Figure 34-6. Paraphimosis The prepuce or foreskin has been retracted proximally over the glans and cannot be replaced to the normal position covering the glans. The shaft is edematous.

Mucocutaneous Disorders

Genital (Penile/Vulvar/Anal) Lentiginoses ICD-9: 709.8 ° ICD-10: L98.8 image

image Onset: Adulthood.

image Clinical findings: Tan, brown, intense blue-black; usually variegated, 5- to 15-mm macules.

image Sites: In clusters on vulva (labia minora, Fig. 34-7), penis (glans, shaft) (Fig. 34-8), and perianal areas.

image Course: Persist for years without change in size.

image Histology: No significant melanocytic hyperplasia; nevus cells are not present; pigmentation due to increased melanin in basal cell layer.

image Differential diagnosis: Melanoma in situ, PUVA lentigo, fixed drug reaction, blue nevus, HPV-induced intraepithelial neoplasia (IN).

image Diagnosis: Dermoscopy rules out in situ melanoma; histology confirms diagnosis.

image Extensive lesions that cannot be easily removed should be followed photographically; areas that show significant change should be biopsied.

image Synonyms: Penile lentigo, vulvar melanosis.


Figure 34-7. Genital lentiginoses: vulva Multiple, variegated dark brown macules, bilaterally on the labia minora. Acrolentiginous melanoma in situ must be ruled out.


Figure 34-8. Genital lentiginoses: penis Variegated macular pigmentation of the glans and foreskin for over 20 years. Biopsy ruled out melanoma and HVP-infection (SCCIS).

Vitiligo and Leukoderma (See also Section 13) image

image Etiology: Loss of melanocytes results in depigmentation.

image Isomorphic or Koebner phenomenon: Depigmentation at sites of injury: genital herpes, cryosurgery, imiquimod therapy.

image Wood lamp examination: Differentiates depigmentation from hypopigmentation.

image Clinical findings: Sharply demarcated, depigmented, white macules (Fig. 34-9); examine skin for other depigmented areas.

image Differential diagnosis: Lichen sclerosus, site of genital herpes; iatrogenic after cryo-, electro-, or laser surgery.

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Dec 17, 2016 | Posted by in Dermatology | Comments Off on 34 DISORDERS OF THE GENITALIA, PERINEUM, AND ANUS

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