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Photo Quiz

Contributing editor is Marc S. Berger, M.D., C.M.
The Reading Hospital and Medical Center, Reading, Pennsylvania

Projections on the Glans Penis A 24-year-old black man presented with painless small nodules on the penis (see the accompanying figure). He was referred for evaluation by his wife's physician because she had human papillomavirus infection, which had been identified through a Papanicolaou smear. The patient had no significant past medical history. Question What are the lesions that are seen in the photograph?  A. Remnants of circumcision skin tags.  B. Adhesions from the glands to the foreskin that have been ruptured by forcible retraction of the foreskin.  C. Micro condyloma acuminata.  D. Pearly penile papules.  E. Condyloma lata.

Discussion

The answer is D: pearly penile papules. Pearly penile papules^1,2 are relatively common benign tumors that occasionally occur in uncircumcised males such as this patient (note that in the photograph, the foreskin was retracted for better visualization). Histologically, these angiofibromas are seen as regular projections from the edge of the glans at the coronal margin. Studies³ have shown that these angiofibromas do not contain HPV DNA by polymerase chain reaction; therefore, they are not condyloma acuminata. Nor are they condyloma lata, which are the moist condylomas seen in secondary syphilis. Reassurance is usually the only treatment necessary, but occasionally patients may request that the papules be removed. Treatment may consist of cryosurgery⁴ or laser therapy.⁵ This patient was reassured and discharged to routine follow-up.

MARC S. BERGER, M.D., C.M.
Contributing Editor

REFERENCES

1. Lynch PJ, Edwards L. Genital dermatology. New York: Churchill Livingstone, 1994:128.
2. George WM. Papular pearly penile pearls. J Am Acad Dermatol 1989;20(5 Pt 1):852.
3. Ferenczy A, Richart RM, Wright TC. Pearly penile papules: absence of human papillomavirus DNA by the polymerase chain reaction. Obset Gynecol 1991;78(1):118-22.
4. Ocampo-Candiani J, Cueva-Rodriguez JA. Cryosurgical treatment of pearly penile papules. J Am Acad Dermatol 1996;35(3 Pt 1):486-7.
5. Magid M, Garden JM. Pearly penile papules: treatment with the carbon dioxide laser. J Dermatol Surg Oncol 1989;15(5):552-4.

The editors of AFP welcome the submission of photographs and material for the Photo Quiz department. Send photograph and discussion to Marc S. Berger, M.D., C.M., Associate Director, Family Medicine Residency, The Reading Hospital and Medical Center, P.O. Box 16052, Reading, PA 19612.

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