Which of the following are NOT recognised preventative measures for penile squamous cell carcinoma?
Answer E
Prophylactic HSV vaccination. All would be potentially useful except vaccination against HSV, which has no proven causal link to penile cancer.
Which of the following viruses is consistently found on histological review in up to 50% of specimens and has a causal role in the pathogenesis of penile squamous cell carcinoma?
Answer B
HPV type 16 appears most prevalent in Europe, North and South America and India. Many studies to date have found HPV type 16 present in up to 50% of cases, when penile SCC histology has been retrospectively reviewed. Although several risk factors for the development of penile SCC are well known (see list below) the exact pathogenesis is largely unknown. There appears to be at least two pathways, an HPV associated and a (non-HPV associated) chronic inflammatory associated pathway. The likely HPV related proteins involved are E6 and E7. They are known to bind to and inactivate the host cell tumour suppressor genes p53 and pRb both are negative regulators of cellular proliferation.
Recent work by Calmon and associates found a link between the HPV 16 related E6 protein and the ANXA1 gene. ANXA1 is one of the Annexin super family proteins involved with differentiation, apoptosis, proliferation and inflammation. It is proposed that E6 can interfere with the regulation of expression of genes by interacting and binding to TNF alpha-receptor 1, FAS-associated protein with death domain (FADD) and Caspase 8 and via degradation of pro-apoptotic BAX and BAK. Other recognised risk factors include smoking, increasing age >60 years, poor personal hygiene, phimosis (present in 25% of penile cancer patients), PUVA therapy, BXO or lichen sclerosus et atrophicus. The exact pathologic role of chronic inflammatory conditions like BXO in the aetiology of penile cancer remains largely unknown.
Which of the following penile dermatosis is NOT associated with penile cancer?
Condyloma acuminatum is a predominantly a sexually transmitted infection caused by human papillomavirus (HPV) and spread through oral, anal and genital sexual contact and is therefore a benign condition. All of the other genital dermatoses are associated with penile SCC. Lichen sclerosus and Bowenoid papulosis are sporadically associated with penile SCC, whereas, Paget’s disease and Buschke–Löwenstein are precancerous lesions and up to 30% transform into invasive SCC.
A 69-year-old man presents to your clinic with the following lesion
on his glans and inner prepuce. The lesion persists despite topical steroid and antifungal creams. A biopsy is obtained and reveals undifferentiated PeIN. What is this lesion known as?
Answer C
PeIN affecting the glans penis or inner prepuce is referred to as erythroplasia of Queyrat (EQ). In comparison to Bowen disease it is when the skin of the penile shaft, rest of the genitalia or the perineum are affected. Management and treatment involve histopathological diagnosis and treatment options focus on penile-sparing procedures, including topical chemotherapy agents, WLE, glans resurfacing, laser therapy (CO2, neodymium:yttrium-aluminum-garnet [Nd:YAG], potassium titanyl phosphate [KTP]) and Moh’s micrographic surgery (not common practice in the UK). When the lesions are located solely on the foreskin, circumcision is often adequate for local control.
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