​Dermatology - Squamous Cell Carcinoma of the Perineum

​Dermatology - Squamous Cell Carcinoma of the Perineum 
The development of squamous cell carcinoma in the perineum is attributed to infection by the human papilloma virus, as well as chronic low-grade balanoposthitis and chronic dermatoses such as ulcerative lichen planus and lichen sclerosus.


Pruritus, ulceration, and precursor lesions may be observed.
The penis, vulva, and anogenital region have distinct, isolated, irregularly shaped patches, papules, or plaques that are either red or white. These patches have a smooth or velvety surface and are characterized by excessive keratinization. Penile lesions may exhibit slight hardening and can be accompanied by tissue death or a secondary infection in the tight foreskin. Vulvar lesions can manifest as either bulky and white growths or as pigmented areas of thickened or hardened skin. The individual may experience pain, discharge, difficulty urinating, bleeding, and the formation of ulcers in a specific area.

The diagnosis is established through clinical examination and subsequently confirmed by performing a biopsy of the affected area. The presence of a nodule or ulcer indicates the advancement of the disease into an invasive stage. In cases of HPV-associated disease, the likelihood of progressing to invasive disease is rather low, however it is higher for vulvar lesions.
The differential diagnosis encompasses various distinct pink-red plaques, such as nummular eczema, psoriasis, seborrheic keratosis, solar keratoses, verruca vulgaris, verruca plana, condyloma acuminatum, superficial basal cell carcinoma, amelanotic melanoma, and nonmammary Paget disease.

The treatment options include topical application of 5-fluorouracil, either with or without occlusion, as well as imiquimod, cryosurgery, CO2 laser evaporation, or excision, including Mohs micrographic surgery.
Topical chemotherapy requires a significant amount of time. Cryosurgery can result in the formation of scars.
Laser therapy can be arduous and agonizing. Surgical excision offers the most effective treatment with the highest likelihood of complete recovery. However, it also has the greatest risk of leaving scars. Nonetheless, it should be employed whenever the possibility of invasion has not been ruled out by a biopsy.