Precancerous and Associated Lesions

Penile precancerous lesions encompass a morphological spectrum of epithelial lesions ranging from extremely well-differentiated precursors, almost indistinguishable from reactive processes, to lesions with the typical aspect of a carcinoma in situ. Nomenclature for these precancerous lesions has been inconsistent and nonstandardized and terms such as Bowen's disease, erythroplasia of Queyrat, penile squamous intraepithelial lesion (low and high grade), dysplasia (mild, moderate, and severe), and carcinoma in situ, have been in use for several years.35,36 Recently, we had proposed a novel classification system, based on cell morphology, squamous differentiation, and pathogenesis.37 Penile intraepithelial neoplasia (PeIN), according to this view, is classified into differentiated (squamous, simplex) and warty, basaloid, and mixed warty-basaloid subtypes. Differentiated PeIN is the most common subtype, frequently associated with lichen sclerosus and usually not associated with HPV. On the contrary, warty and/or basaloid PeIN, less common lesions, are usually p16INK4a positive and most likely related to HPV.37

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