Pseudoepitheliomatous keratotic and micaceous balanitis with malignant transformation
A 40-year-old male presented with thick, hard lesions over the penis of 5 years duration, which were progressive in nature and associated with deviation of urinary stream. In some areas, yellowish white scales were seen with free edges. The scales were easily removable after rubbing, however, the scales recurred. He later developed phimosis for which he underwent circumcision. There was no history of sexually transmitted infection and diabetes mellitus. The patient gave history of use of anti-bacterial and keratolytic creams with no improvement.\nExamination revealed thick, non-tender, hard, keratotic yellowish plaques localized on the glans and partially obstructing the external urinary meatus, measuring about 2 cm × 1.5 cm in size with micaceous scaling and fissures at places []. The penile shaft and scrotum were normal. There was no inguinal or femoral lymphadenopathy. General and systemic examination revealed no abnormality.\nBlood counts and blood sugar levels were within normal limits. Tests for HIV antibodies, hepatitis B surface antigen were negative and Venereal Disease Research Laboratory test was non-reactive. Wedge biopsy from the glans revealed features of acanthosis, hyperkeratosis, parakeratosis with cellular atypia and abnormal mitosis suggestive of malignant transformation [].\nA diagnosis of PKMB of Civatte with carcinoma in situ was made and the patient underwent a partial penectomy []. He has been asked to follow-up every month to check for any new growths and lymphadenopathy.