Erythroplasia of Keir: causes, symptoms, diagnosis, treatment

Erythroplasia of Queyrat (syn.: epithelioma velvetica, velvety epithelioma) is cancer in situ, compared to Bowen's disease it metastasizes more often, which is possibly due to the peculiarities of localization. It occurs on the head of the penis, female genitals, in the perianal area or (rarely) on the mucous membrane of the oral cavity. Oncogenic human papillomavirus type 16 or 33 is detected in 70% of cases.

Causes and pathogenesis of erythroplasia of Queyrat. Erythroplasia of Queyrat is considered an intraepidermal cancer and belongs to the group of carcinomas in situ. Failure to observe personal hygiene is of great importance in the development of the disease. Many dermatologists believe that erythroplasia of Queyrat is a variant of Bowen's disease of the mucous and semi-mucous membranes.

Symptoms of Queyrat's erythroplasia. Queyrat's erythroplasia occurs much more often in men, usually over 50 years of age, who have not been circumcised. In most cases, a single, slightly edematous lesion appears on the genitals (in men - the head of the penis, foreskin, in women - the vulva area), which has sharply defined uneven borders, a round or oval shape. Mild infiltration in the lesion and soreness are noted. Its surface is characteristic - deep red, often with a brownish tint, moist, shiny, glossy, as if velvety. Over time, increased infiltration is observed, sometimes erosion of the lesion. In the case of a secondary infection, purulent discharge is noted, and the lesion is covered with a yellowish coating.

The lesion is usually single, sharply defined, oval or rounded, often with scalloped edges. Its surface is deep red, with a brown tint, moist, shiny, velvety. As the process develops, infiltration becomes more pronounced, the surface can become covered with crusts, bleeds easily, sometimes becomes vegetative, eroded, which can serve as a sign of the development of invasion.

Localizations of Queyrat's erythroplasia have also been described in other areas of the skin and mucous membranes. The disease most often transforms into squamous cell carcinoma.

Histopathology. Changes are similar to the histological picture in Bowen's disease. Uneven acanthosis, focal hyper- and parakeratosis are observed. Atypical cells arise as a result of impaired cell differentiation. An infiltrate consisting mainly of lymphocytes and a small number of plasma cells is observed in the dermis.

Pathomorphology. Small, irregularly located, interconnected strands of atypical cells are found throughout the entire thickness of the epidermis. Unlike the classic picture of Bowen's disease, there is no dyskeratosis. Otherwise, the histological picture corresponds to the basaloid-bowenoid type of proliferation of epidermal strands.

Differential diagnosis. Erythroplasia of Queyrat should be differentiated from balanoposthitis (vulvitis), kraurosis, limited plasmacellular balanoposthitis Zoon, limited psoriasis, eczema, fixed erythema, lichen planus, spinalioma, pagetoid epithelioma, Paget's disease, syphilis. Erythroplasia of Queyrat is also differentiated from bowenoid papulosis, genital form of lichen planus, fixed drug erythema, limited plasmacellular balanitis Zoon, in which the epithelium is usually thinned, the dermis contains a dense inflammatory infiltrate with a large number of plasma cells. Capillaries are usually dilated, hemosiderin deposits may appear. Atypical epithelial growths are not detected. Due to the great clinical similarity of these diseases, the final diagnosis is made on the basis of histological examination data.

Treatment of erythroplasia of Queyrat. Bleomycin, radiation therapy, surgical excision and external cytostatic ointments are prescribed.

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