Erythroplasia Queyrat

Erythroplasia de Queyrat, Queyrat's disease, penile carcinoma in situ, PeIN (penile intraepithelial neoplasia).

Erythroplasia Queyrat is a squamous cell carcinoma in situ of the genital mucosa, usually glans penis or prepuce, rarely vulvar or extragenital. It is characterized by sharply defined, velvety red plaques with complete intraepithelial dysplasia without invasion.

Rare disease, preferably in men (5th-8th decade of life), more frequent in the absence of circumcision. Rare in women (vulvar analog). Extragenital forms extremely rare.

Sub-type of anogenital squamous cell carcinoma in situ (PeIN/VIN).

• HPV-positive (undifferentiated) variant: Erythroplasia Queyrat, Bowenoid papulosis.
• HPV-negative (differentiated) variant: often associated with lichen sclerosus.

Multifactorial, often HPV-associated (especially type 16). Predisposing factors: lack of circumcision, chronic irritation, phimosis, lichen sclerosus, immunosuppression, nicotine.

Chronic, asymptomatic, sharply defined, intensely red plaques with a velvety, shiny surface. Erosions and bleeding possible with progression.

Clinically suspected diagnosis with typical lesion and lack of response to antifungal/corticosteroid treatment. Biopsy essential (carcinoma in situ). Dermatoscopy helpful (glomerular vessels).

Predominantly glans penis, inner prepuce, rarely sulcus coronarius, external urethral meatus, vulvar (small labia, clitoral periphery). Extremely rarely extragenital (oral, anal).

Persistent red plaque, resistant to treatment, often older non-circumsized men. Few symptoms, occasional history of HPV risk factors or chronic dermatoses.

Carcinoma in situ with atypical keratinocytes, complete epithelial dysplasia, intact basement membrane. HPV-associated: possibly koilocytes, p16 positivity.

Progression to invasive carcinoma (10-30% untreated), local invasion, metastasis possible. Recurrences frequent with inadequate therapy.

Excellent with early, complete therapy, cure rate almost 100%. Recurrences possible, regular follow-up recommended.

HPV vaccination, early circumcision, good genital hygiene, reduction of chronic irritation, minimize risk factors (nicotine, HPV exposure).

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