Topical Therapy

Carcinoma in situ accounts for approximately 10% of penile malignancies at diagnosis.12 CIS can arise on the shaft of the penis, where it is called Bowen's disease, or as one or more red, moist patches on the mucosal surfaces of the glans penis or inner prepuce, where it is known as erythroplasia of Queyrat (EQ). CIS can easily be misdiagnosed as a benign skin condition or other penile dermatoses such as candidal balanitis, Zoon's balanitis, or erosive lichen planus. It can also coexist with balanitis xerotica obliterans (BXO). Thus it is important that an early biopsy is taken in order to make the diagnosis and plan treatment. If left untreated, the observed risk of progression to invasive SCC is 5-33%.13

When invasive disease is absent, first-line therapy with topical 5% 5-Fluorouracil (5-FU) cream can be used and has already been discussed in Chap. 5 . Although several regimes exist, the most popular is application on alternate days for a 4 week period although this is adjusted according to the response. Small studies (<10 patients) have shown excellent response rates approaching 100% at 5 years.14 The use of topical chemotherapy is safe and generally well tolerated. Patients who do not respond or who develop recurrence can be offered further topical therapy with 5% Imiquimod given in a similar regime. The success of this immune modulating cream has only been described in case reports.15

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