Erythroplasia of Queyrat is a superficial intraepithelial cancer of the mucous membranes. In most cases, the tumor lesion affects the head of the penis and the inner leaf of the foreskin, less often – the vulva, cervix, perianal region, oral cavity. It is a bright red plaque with a shiny, slightly velvety, moist surface and clear borders. In order to diagnose erythroplasia of Queyrat, a neoplasm biopsy, histological and cytological examination are used. Surgical excision, electrocoagulation, cryodestruction, chemotherapy, and X-ray irradiation have been proposed as methods of treating erythroplasia of Queyrat.
Erythroplasia of Queyrat (bowen disease of the glans penis) is a non—invasive (“cancer in situ”, cancer in situ) cancer localized on the mucous membrane of the genitals. Most often, the head of the penis and the foreskin are involved in the process, but there are also lesions of the vulva. Like Bowen’s disease, in erythroplasia of Queyrat, the tumor is located inside the epidermis and does not spread into the dermis. Meanwhile, in about 30% of cases, erythroplasia of Queyrat degenerates into squamous cell skin cancer, which has a malignant course with metastasis. Erythroplasia of Queyrat is predominantly a “male” disease, therefore, along with dermatology, andrology is studied.
The disease occurs mainly among elderly or middle-aged men who have not had their foreskin circumcised. Carcinogenic factors, negligent attitude to personal hygiene, oncogenic viruses (for example, HPV — human papillomavirus, recurrent genital herpes), constant trauma of the genitals, chronic balanoposthitis play a provoking role in the occurrence of a tumor.
The lesion in erythroplasia of Queyrat is usually single and localized on the inside of the foreskin. It has well-defined edges, pink-red or burgundy-cherry color, velvety or glossy shiny surface. A white plaque may appear on the penis, which is easily removed. Pain is usually insignificant. The pain increases when the area affected by the tumor is injured. For the same reason, bleeding may occur. The addition of infection leads to the formation of a yellow plaque and the appearance of purulent discharge.
During the transition of the Queyrat tumor to squamous cell skin cancer, changes occur in the lesion: warty growths, seals and ulceration covered with bloody crusts or a white coating may appear.
Diagnosis is carried out according to the clinical picture and the results of a histological examination of a tissue sample taken during a biopsy of the affected area. Histological examination of the preparations reveals hyperkeratosis, uneven acanthosis and infiltration of the dermis by lymphocytes, atypical (tumor) cells are found in the epidermis.
To exclude inflammatory diseases of the penis, a sample is carried out with a dye — 1% toluidine blue solution, which is applied to the affected area. With normal redness of inflammatory genesis, staining does not occur, with a Queyrat tumor, the focus acquires a blue color. The differential diagnosis of erythroplasia of Queyrat is carried out with Zoon balanitis, solid chancre (syphilis), erosive-ulcerative leukoplakia, yeast balanoposthitis, limited psoriasis, red lichen planus, etc.
Treatment and prognosis
Queyrat tumor is treated by surgical excision, cryodestruction with liquid nitrogen or electrocoagulation. Effective use of cytostatic ointments: fluorouracil, fluorofuric, and prospidinic. If invasive tumor growth is detected, chemotherapy is performed with intramuscular or intravenous bleomycin. When erythroplasia of Queyrat transforms into squamous cell carcinoma involving regional lymph nodes, treatment includes removal of the affected lymph nodes (lymphadenectomy) and close-focus radiotherapy of the tumor.
Usually, the disease has a long and benign course, without germination into the underlying tissues and without involving regional lymph nodes in the process. The prognosis becomes unfavorable with the transformation of Queyrat tumor into squamous cell skin cancer.