Noninfectious Penile Lesions

1. A 26-year-old man presents with a penile lesion that has existed at least 10 years without significant change and with no attendant symptoms. The lesion consists of four 1-to-1.5-mm soft, compressible purple papules, in aggregate measuring about 8 mm. No other lesions are seen on the genitals or on the body.

Diagnosis: The lesion proved to be angiokeratoma of Fordyce, a totally benign lesion. This type of angiokeratoma is ectatic, thin-walled vessels in the superficial dermis, with overlying epidermal hyperplasia that forms secondary to normal friction. When they are seen on the scrotum, vulva, or penis, they are usually referred to as angiokeratoma of Fordyce, a type of localized angiokeratoma, other types of which can appear on the legs or hands.

These totally benign lesions must be distinguished from generalized types of angiokeratomata, such as those seen in Fabry disease (angiokeratoma corporis diffusum), an inheritable metabolic disorder. With our patient’s history, his lesion was clearly benign.

Had his lesion been new or changing in any substantive way, additional testing, including a biopsy, might have been necessary to rule out entities such as squamous cell carcinoma (which is almost unknown in circumcised patients), condyloma, melanoma, the aforementioned Kaposi’s sarcoma, or even angiosarcoma.

For more information, see “Skin is skin, no matter the location.” Clinician Reviews. 2013 June;23(6):W5.