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Department of Dermatology, “M. Bufalini” Hospital, Cesena, Italia
Erythroplasia of Queyrat (EQ) is an intraepidermal squamous cell carcinoma mainly affecting the genital mucosa. It presents as a round or polycyclic erythematous plaque with well-demarcated borders and a velvety, shiny, bright red surface.
Lesions usually occur after the fifth decade of life, the course of the disease is chronic and, if left untreated, progress to invasive carcinoma in 10-30% of cases. It is thought that EQ is the result of a process involving a number of factors: phimosis, irritant balanitis due to the accumulation of smegma, HPV infections and a large number of sexual partners. Clinical diagnosis must always be confirmed by histopathological examination. Microscopic examination reveals that the greatest changes occur in the Malpighian layer where acanthosis, sporadic dyskeratoses, atypical cells with polymorph nuclei and rare mitoses can be seen. The chorion shows a moderate superficial lymphoplasma cell infiltrate. Differential diagnoses include balanoposthitis, Zoon’s plasma cell balanitis, fixed drug reactions, and psoriasis. Small neoplasia can be surgically removed, while larger lesions, where surgery would be too mutilating, can be treated with cryotherapy or laser ablation. Circumcision is recommended in all cases to improve hygiene and prevent recurrences. Patients with EQ must undergo periodical check-ups for at least 5 years to be sure of complete healing.