Pseudoepitheliomatous keratotic and micaceous balanitis
A 65-year-old male presented with a chronic nonhealing lesion over his penis since 6 months. It was associated with occasional itching, irritation, and burning sensation following micturition. There was no history of bleeding either spontaneously or following minimal trauma. Clinical examination, after retracting the prepuce, revealed a well-defined hyperkeratotic plaque with thick adherent micaceous scales surrounded by a slight erythematous halo []. There was no regional lymphadenopathy. Based on these findings, biopsy of the lesion was performed under local anesthesia with clinical differential diagnoses of verrucous/squamous cell carcinoma (SCC) and lichen sclerosus in mind. Histopathology of the lesion revealed epidermal hyperkeratosis, parakeratosis, acanthosis, and papillomatosis (features of pseudoepitheliomatous hyperplasia) with perivascular mononuclear cell infiltrate in the dermis []. There were no cellular dysplasia or frank neoplastic changes and the basement membrane was intact. Based on these clinical and histopathological findings, a diagnosis of PKMB was made. Patient is on treatment with topical 5-fluorouracil (5-FU; 5%) cream once-a-day [], and is being regularly followed-up.