Penis ans Scrotum
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The penis and scrotum are sites for
developmental, infective, dermatological, and neoplastic diseases.
Malformations of the penis and penile urethra may occur, which are particularly
associated with maldescent of the testes. Aetiology is uncertain, but exposure
to oestrogens in utero has been suggested as a potential cause. For example, in
hypospadias there is abnormal opening of the urethra onto the ventral surface of
the penis, and in epispadias there is abnormal opening of the urethra onto the
dorsal surface of the penis.
Phimosis is a condition in which the foreskin is abnormally tight and does not
retract easily over the glans penis. A complication is inability to release the
foreskin after it has been retracted, causing painful swelling of the glans (paraphimosis).
Inflammation of the glans, which is termed balanitis, may be caused by a variety
of bacterial organisms, being predisposed by poor hygiene or phimosis.
The penis is prone to develop a number of skin diseases, e.g. lichen planus,
psoriasis, viral warts, and molluscum contagiosum.
In balanitis xerotica obliterans (BXO) the foreskin becomes abnormally thickened
and scarred, resulting in phimosis. This is a primary inflammatory skin
condition, identical in pathology to the vulval and skin disease lichen
The most important neoplastic lesion of the penis is squamous cell carcinoma.
This develops either as a well-differentiated keratinizing invasive form,
usually seen in elderly men, or as the non-invasive carcinoma in situ form (Queyrat's
erythroplasia), presenting as a red patch or indurated plaque, similar to
intraepidermal carcinoma of the skin. There is a spectrum of changes from
dysplasia to carcinoma in situ, grouped together as 'penile intraepithelial
neoplasia' (PIN); many cases are associated with human papillomavirus infection.
Invasive squamous cell carcinoma occurs most commonly in uncircumcised men,
presenting as a warty cauliflower-like growth that bleeds easily. It tends to
grow slowly, but is often neglected because of patient embarrassment; the most
common site of spread is to the inguinal lymph nodes via lymphatics.
The skin of the scrotum is a common location for a number of skin disorders
including epidermal cysts, nodular calcinosis cutis, and some inflammatory skin
diseases such as psoriasis. It is the site of an unusual type of superficial
venous infarction known as 'Fournier's gangrene'.
The most important tumour of the scrotum is invasive squamous carcinoma. This is
now rare, but was of importance historically because of its known association
with the occupation of chimney sweep.
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