General
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• Benign HPV-related condition characterized by multiple soft papules, most commonly in the skin of the shaft, that usually regress spontaneously (eMedicine)
• Originally described in 1977 by Kopf and Bart (J Dermatol Surg Oncol 1977;3:265)

Terminology
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• Type of penile intraepithelial neoplasia (males) or vulvar intraepithelial neoplasia (females)

Epidemiology
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• Preferentially affects sexually active young males (mean age 30 years)

Sites
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• Primarily penile shaft; may also be present in foreskin, glans or scrotum

Etiology
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• Sexually transmitted disease associated with HPV 16 or 18

Clinical features
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• Occurs in young, sexually active population
• Clinically resembles condyloma, but histologically resembles Bowen’s disease
• Usually regresses spontaneously (mean duration of disease is 2 months), leaving no sequelae
• Either macular or papular
• Less than 1% progress to penile cancer

Prognostic factors
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• None identified

Treatment
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• Often regresses spontaneously
• Local agents include 5 fluorouracil, imiquimod, podophyllin and cidofovir (Indian J Dermatol 2009;54:283)
• Also retinoids (topical or systemic), excision, electrocautery, CO2 laser, cryosurgery, photodynamic therapy and interferon

Clinical images
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Penile lesions

Lesion of shaft

Typical appearance in female

Various images

Two small papules
with irregular margins

Gross description
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• Multiple small pigmented papular lesions, may resemble condyloma acuminatum

Micro description
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• Resembles basaloid PeIN, but may have mild / heavy melanin pigmentation within the lesion, and atypical cells are more spotty
• Often spiky or flat appearance
• May have less cytologic atypia

Micro images
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Epidermal dysmaturation and dyskeratosis

Acanthosis and epidermal dysmaturation / dyskeratosis

Acanthosis and spotty distribution of atypical cells

Differential diagnosis
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• Penile intraepithelial neoplasia: different clinical history; atypical cells are more diffuse, less maturation of keratinocytes

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