Erythroplasia of Queyrat (Bowen Disease of the Glans Penis)



Erythroplasia of Queyrat (EQ) is an in situ squamous cell carcinoma of the penis.[1] The glans and prepuce are most commonly involved.[2] Erythroplasia of Queyrat is seen almost exclusively in uncircumcised men. Progression to invasive carcinoma may occur, and spontaneous regression is unlikely.[3, 4]

Erythroplasia of Queyrat was originally described by Tarnovsky in 1891 and later appreciated as a penile disease by Fournier and Darier in 1893. Studies by Queyrat in 1911 allowed erythroplasia of Queyrat to be accepted as a distinct entity. In 1933, Sulzberger and Satenstein recognized erythroplasia of Queyrat as a form of carcinoma in situ.[5]

Some references equate erythroplasia of Queyrat with the term Bowen disease of the glans penis”.[6] The term erythroplasia of Queyrat is used for squamous cell carcinoma in situ (SCCIS) of the mucocutaneous epithelium of the penis.[1]

Some references extend use of the term erythroplasia of Queyrat to also describe SCCIS of the labia minora, vestibule, vulva, labia majora, conjunctivae, buccal mucosa, and anal mucosa.[1, 4, 7]


The etiology of erythroplasia of Queyrat remains unclear. The following have been proposed to contribute to the development and progression of erythroplasia of Queyrat[1, 4, 6, 8, 9, 10, 11] :



Erythroplasia of Queyrat is a rarely reported disorder. It makes up less than 1% of malignancies in males.[6]


Erythroplasia of Queyrat is a disease of middle-aged to elderly males.[8] It has been described in males ranging from age 20-80 years.[12]


The cure rate for erythroplasia of Queyrat is high if lesions are identified and treated early.

If urethral involvement is noted, treatment may be both more challenging and lead to higher recurrence rates.[6]

Transformation to invasive carcinoma is possible within erythroplasia of Queyrat lesions. Graham and Helwig reported 10% of erythroplasia of Queyrat cases progressing to malignant disease.[12] Others report progression rates as high as 33%.[4] Cases of erythroplasia of Queyrat metastatic to local lymph nodes have also been reported.[13]


Patients with erythroplasia of Queyrat (EQ) typically present with solitary or multiple, often times nonhealing, lesions on the glans penis and/or adjacent mucosal epithelium.[1]

Presenting symptoms can vary and may include the following:

Physical Examination

Single or multiple, nontender, slightly raised, red papules and plaques on the glans penis and/or adjacent mucosal epithelium are seen in erythroplasia of Queyrat; the inner surface of the foreskin or coronal sulcus may be involved.[1] The plaques may appear smooth, velvety, scaly, crusty, or verrucous. Note the image below.

The patient is usually uncircumcised.[14]

There may also be involvement or the urethral meatus.[9]

View Image

Erythroplasia of Queyrat. Courtesy of Hon Pak, MD.


Dermatological and urological complications may occur.

Laboratory Studies

The diagnosis of erythroplasia of Queyrat (EQ) is made via histological examination. Specifically, biopsy should be performed on any areas with signs of bleeding, ulceration, or papillomatous change.[6] Additionally, biopsy should be performed on therapy-resistant lesions.[1] The following diagnostic procedures may be useful in excluding other infectious processes:

Early invasive disease should be evaluated for with several biopsies as needed.[6] Failure to carefully evaluate any patient, especially uncircumcised patients, presenting with a subacute or chronic balanitis is a potential medicolegal pitfall. The threshold for performing skin biopsy of any lesion should be very low. In addition, a failure to diagnose erythroplasia of Queyrat expediently can easily result in disease that progresses to frank squamous cell carcinoma of the penis.

Some authors have also called for optical coherence tomography in conjunction with skin biopsy.[15]



Histologic Findings

Histologic findings include the following[14, 9] :

Medical Care

Cases of erythroplasia of Queyrat (EQ) have been treated with the following:

Surgical Care

Surgical treatments for erythroplasia of Queyrat include the following[23] :

Circumcision is recommended.[6]

Long-Term Monitoring

Close follow-up is recommended for patients treated medically or surgically.[35]

Medication Summary

Several case reports describe limited success in treating selected superficial lesions of erythroplasia of Queyrat (Bowen disease of the glans penis) with topical 5-fluorouracil 5% cream.

Several case reports and series describe successful treatment of noninvasive erythroplasia of Queyrat (Bowen disease of the glans penis) with topical imiquimod 5% cream.


Vikas Shrivastava, MD, Resident Physician, Department of Dermatology, Naval Medical Center San Diego

Disclosure: Nothing to disclose.


Kendall M Egan, MD, FAAD, Dermatologist, Veteran's Affairs Medical Center; Dermatologist, Spruce Health, Dermatologist, DermOne

Disclosure: Nothing to disclose.

Kimberly L Maino, MD, Mohs Surgeon and Dermatologist, Aurora Skin Care Center

Disclosure: Nothing to disclose.

Specialty Editors

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Mark W Cobb, MD, Consulting Staff, WNC Dermatological Associates

Disclosure: Nothing to disclose.


Mary Farley, MD Dermatologic Surgeon/Mohs Surgeon, Anne Arundel Surgery Center

Disclosure: Nothing to disclose.

Joseph L Wilde, MD Chief, Department of Dermatology, Vicenza Army Health Center, Italy

Joseph L Wilde is a member of the following medical societies: American College of Mohs Micrographic Surgery and Cutaneous Oncology

Disclosure: Nothing to disclose.


The views expressed in this manuscript are those of the authors and do not reflect the official policy of the Department of the Navy, Department of the Army, Department of Defense, or the US Government. The authors are employees of the US Government and military service members. This work was prepared as part of their official duties. Title 17, USC, § 105 provides that 'Copyright protection under this title is not available for any work of the United States Government.' Title 17, USC, § 101 defines a US Government work as a work prepared by a military service member or employee of the US Government as part of that person's official duties.


  1. Kirnbauer R, Lenz P, Bolognia J, Jorizzo J, and Schaffer J. Human Papillomaviruses. Dermatology. 3rd ed. Philadelphia, Pa: Elsevier Saunders; 2012. Vol 2: 1309-20.
  2. Maranda EL, Nguyen AH, Lim VM, Shah VV, Jimenez JJ. Erythroplasia of Queyrat treated by laser and light modalities: a systematic review. Lasers Med Sci. 2016 Dec. 31 (9):1971-1976. [View Abstract]
  3. Micali G, Innocenzi D, Nasca MR, Musumeci ML, Ferrau F, Greco M. Squamous cell carcinoma of the penis. J Am Acad Dermatol. 1996 Sep. 35(3 Pt 1):432-51. [View Abstract]
  4. Henquet CJ. Anogenital malignancies and pre-malignancies. J Eur Acad Dermatol Venereol. 2011 Aug. 25(8):885-95. [View Abstract]
  5. Goette DK. Review of erythroplasia of Queyrat and its treatment. Urology. 1976 Oct. 8(4):311-5. [View Abstract]
  6. Kutlubay Z, Engin B, Zara T, Tüzün Y. Anogenital malignancies and premalignancies: facts and controversies. Clin Dermatol. 2013 Jul-Aug. 31(4):362-73. [View Abstract]
  7. Ruocco E, Brunetti G, Del Vecchio M, Ruocco V. The practical use of cytology for diagnosis in dermatology. J Eur Acad Dermatol Venereol. 2011 Feb. 25(2):125-9. [View Abstract]
  8. Divakaruni AK, Rao AV, Mahabir B. Erythroplasia of Queyrat with Zoon's balanitis: a diagnostic dilemma. Int J STD AIDS. 2008 Dec. 19(12):861-3. [View Abstract]
  9. Fanning DM, Flood H. Erythroplasia of queyrat. Clin Pract. 2012 May 29. 2(3):e63. [View Abstract]
  10. Wieland U, Jurk S, Weissenborn S, Krieg T, Pfister H, Ritzkowsky A. Erythroplasia of queyrat: coinfection with cutaneous carcinogenic human papillomavirus type 8 and genital papillomaviruses in a carcinoma in situ. J Invest Dermatol. 2000 Sep. 115(3):396-401. [View Abstract]
  11. Nasca MR, Potenza MC, Alessi L, Paravizzini G, Micali G. Absence of PCR-detectable human papilloma virus in erythroplasia of Queyrat using a comparative control group. Sex Transm Infect. 2010 Jun. 86(3):199-201. [View Abstract]
  12. Graham JH, Helwig EB. Erythroplasia of Queyrat. A clinicopathologic and histochemical study. Cancer. 1973 Dec. 32(6):1396-414. [View Abstract]
  13. Kim B, Garcia F, Toma N, et al. A rare case of penile cancer in siu metastasizing to lymph nodes. Can Urol Assoc J. 2007. 1:404-7.
  14. Johnston RB and Weedon D. Tumors of the Epidermis. Weedon's Skin Pathology Essentials. Edinburgh: Elsevier Churchill Livingstone; 2012. 31.
  15. Schmitz L, Bierhoff E, Dirschka T. Optical coherence tomography imaging of erythroplasia of Queyrat and treatment with imiquimod 5% cream: a case report. Dermatology. 2014. 228 (1):24-6. [View Abstract]
  16. Harrington KJ, Price PM, Fry L, Witherow RO. Erythroplasia of Queyrat treated with isotretinoin. Lancet. 1993 Oct 16. 342(8877):994-5. [View Abstract]
  17. Micali G, Nasca MR, De Pasquale R. Erythroplasia of Queyrat treated with imiquimod 5% cream. J Am Acad Dermatol. 2006 Nov. 55(5):901-3. [View Abstract]
  18. Conejo-Mir JS, Munoz MA, Linares M, Rodriguez L, Serrano A. Carbon dioxide laser treatment of erythroplasia of Queyrat: a revisited treatment to this condition. J Eur Acad Dermatol Venereol. 2005 Sep. 19(5):643-4. [View Abstract]
  19. Arlette JP. Treatment of Bowen's disease and erythroplasia of Queyrat. Br J Dermatol. 2003 Nov. 149 Suppl 66:43-9. [View Abstract]
  20. Orengo I, Rosen T, Guill CK. Treatment of squamous cell carcinoma in situ of the penis with 5% imiquimod cream: a case report. J Am Acad Dermatol. 2002 Oct. 47(4 Suppl):S225-8. [View Abstract]
  21. Micali G, Lacarrubba F, Dinotta F, Massimino D, Nasca MR. Treating skin cancer with topical cream. Expert Opin Pharmacother. 2010 Jun. 11(9):1515-27. [View Abstract]
  22. Deen K, Burdon-Jones D. Imiquimod in the treatment of penile intraepithelial neoplasia: An update. Australas J Dermatol. 2016 Mar 8. [View Abstract]
  23. Gerber GS. Carcinoma in situ of the penis. J Urol. 1994 Apr. 151(4):829-33. [View Abstract]
  24. Brown MD, Zachary CB, Grekin RC, Swanson NA. Genital tumors: their management by micrographic surgery. J Am Acad Dermatol. 1988 Jan. 18(1 Pt 1):115-22. [View Abstract]
  25. Feldmeyer L, Krausz-Enderlin V, Töndury B, et al. Methylaminolaevulinic acid photodynamic therapy in the treatment of erythroplasia of Queyrat. Dermatology. 2011. 223(1):52-6. [View Abstract]
  26. Jia QN, Nguyen GH, Fang K, Jin HZ, Zeng YP. Development of squamous cell carcinoma from erythroplasia of Queyrat following photodynamic therapy. Eur J Dermatol. 2018 Jun 1. 28 (3):405-406. [View Abstract]
  27. van Bezooijen BP, Horenblas S, Meinhardt W, Newling DW. Laser therapy for carcinoma in situ of the penis. J Urol. 2001 Nov. 166(5):1670-1. [View Abstract]
  28. Del Losada JP, Ferré A, San Román B, Vieira V, Fonseca E. Erythroplasia of Queyrat with urethral involvement: treatment with carbon dioxide laser vaporization. Dermatol Surg. 2005 Nov. 31(11 Pt 1):1454-7. [View Abstract]
  29. Yamaguchi Y, Hata H, Imafuku K, Kitamura S, Shimizu H. A case of erythroplasia of Queyrat successfully treated with combination carbon dioxide laser vaporization and surgery. J Eur Acad Dermatol Venereol. 2016 Mar. 30 (3):497-8. [View Abstract]
  30. Lee MR, Ryman W. Erythroplasia of Queyrat treated with topical methyl aminolevulinate photodynamic therapy. Australas J Dermatol. 2005 Aug. 46(3):196-8. [View Abstract]
  31. Davis-Daneshfar A, Trueb RM. Bowen's disease of the glans penis (erythroplasia of Queyrat) in plasma cell balanitis. Cutis. 2000 Jun. 65(6):395-8. [View Abstract]
  32. Skroza N, LA Viola G, Pampena R, Proietti I, Bernardini N, Tolino E, et al. Erythroplasia of Queyrat treated with methyl aminolevulinate-photodynamic therapy (MAL-PDT): case report and review of the literature. G Ital Dermatol Venereol. 2016 Dec 1. [View Abstract]
  33. Fai D, Romano I, Cassano N, Vena GA. Methyl-aminolevulinate photodynamic therapy for the treatment of erythroplasia of Queyrat in 23 patients. J Dermatolog Treat. 2011 Sep 4. [View Abstract]
  34. Calzavara-Pinton PG, Rossi MT, Sala R. A retrospective analysis of real-life practice of off-label photodynamic therapy using methyl aminolevulinate (MAL-PDT) in 20 Italian dermatology departments. Part 2: oncologic and infectious indications. Photochem Photobiol Sci. 2013 Jan. 12(1):158-65. [View Abstract]
  35. Porter WM, Francis N, Hawkins D, Dinneen M, Bunker CB. Penile intraepithelial neoplasia: clinical spectrum and treatment of 35 cases. Br J Dermatol. 2002 Dec. 147(6):1159-65. [View Abstract]

Erythroplasia of Queyrat. Courtesy of Hon Pak, MD.

Erythroplasia of Queyrat. Courtesy of Hon Pak, MD.