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OVERVIEW

image SUMMARY

  • Tumors can arise from any tissue within the penis or the vulva, and benign lesions are likely underreported. Treatment may range from simple observation to radical excision, depending on tumor features and patient symptoms.

  • Likewise, scrotal tumors can arise from either the overlying epidermis or underlying dermal structures, though they are usually rare.

  • Squamous cell carcinoma is the most common malignancy of the penis, vulva, and scrotum. Metastasis occurs primarily to the inguinal lymph nodes, and treatment is determined based on the stage of the disease.

  • Extramammary Paget disease is more common among females and is considered premalignant by many, though lesions often appear benign. Surgery is the standard of treatment, but recurrence is common.

image DON’T FORGET

  • Melanoma should always be ruled out in the case of pigmented lesions, as patients with genital melanomas often undergo diagnostic delays and have worse survival rates when compared with patients with cutaneous melanomas at other sites.

  • Several factors may influence patients not to disclose the occurrence of new genital lesions or symptoms. Health care providers should keep this in mind and take a sensitive approach to acquire a thorough patient history.

image CLINICAL PEARLS

  • Infection with human papillomavirus (HPV) is a risk factor for several genital lesions, including condylomata, giant condylomata, intraepithelial neoplasia, and squamous cell carcinoma. However, intraepithelial neoplasia and squamous cell carcinomas may also develop via HPV-independent pathways.

  • Verruciform xanthomas can mimic both benign and malignant lesions; therefore, proper identification is important to avoid unnecessary and excessive treatment.

  • Dermoscopy may serve as a useful aid to differentiate benign versus potentially malignant conditions prior to biopsy.

image PATIENT EDUCATION POINTS

  • Patients should alert their health care providers to the presence of new genital lesions with or without abnormal genital discharge, bleeding, inflammation, pruritus, or pain, as well as associated dyspareunia, dysuria, or a nonretractable foreskin.

  • Depending on lesion type and extent, several treatment options exist that aim to maximally preserve appearance and function. Local approaches may be curative for early-stage malignant disease; therefore, open communication is important to maximize outcomes.

INTRODUCTION

Neoplasms occurring in the skin of the genitals are similar to those occurring in other regions of skin. However, it is important to consider the associated psychological issues posed by lesions in this sensitive region as they can affect their detection, diagnosis, and treatment. The clinician must keep this in mind when evaluating and communicating with patients to ensure optimal management.

TUMORS OF THE PENIS

Tumors of the penis may arise from the penile skin as well as the tissues within the shaft, which then involve the overlying skin. Examples include connective tissue sarcomas, urethral carcinomas, and extramammary Paget disease (EMPD).

Several benign lesions occur on the skin of the penis. Pigmented macules, though seemingly uncommon, are likely underreported (Figure 23-1). They also ...

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