Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
Am Fam Physician. 2010 Jan 15;81(2):167-74.
Family physicians commonly diagnose and manage penile cutaneous lesions. Noninfectious lesions may be classified as inflammatory and papulosquamous (e.g., psoriasis, lichen sclerosus, angiokeratomas, lichen nitidus, lichen planus), or as neoplastic (e.g., carcinoma in situ, invasive squamous cell carcinoma). The clinical presentation and appearance of the lesions guide the diagnosis. Psoriasis presents as red or salmon-colored plaques with overlying scales, often with systemic lesions. Lichen sclerosus presents as a phimotic, hypopigmented prepuce or glans penis with a cellophane-like texture. Angiokeratomas are typically asymptomatic, well-circumscribed, red or blue papules, whereas lichen nitidus usually produces asymptomatic pinhead-sized, hypopigmented papules. The lesions of lichen planus are pruritic, violaceous, polygonal papules that are typically systemic. Carcinoma in situ should be suspected if the patient has velvety red or keratotic plaques of the glans penis or prepuce, whereas invasive squamous cell carcinoma presents as a painless lump, ulcer, or fungating irregular mass. Some benign lesions, such as psoriasis and lichen planus, can mimic carcinoma in situ or squamous cell carcinoma. Biopsy is indicated if the diagnosis is in doubt or neoplasm cannot be excluded. The management of benign penile lesions usually involves observation or topical corticosteroids; however, neoplastic lesions generally require surgery.
家庭医生通常会诊断和处理阴茎皮肤病变。非传染性病变可分为炎症性和丘疹鳞屑性（如银屑病、硬化性苔藓、血管角皮瘤、扁平苔藓、苔藓样糠疹）或肿瘤性（如原位癌、浸润性鳞状细胞癌）。病变的临床表现和外观有助于诊断。银屑病表现为红色或鲑鱼色斑块，伴有覆盖其上的鳞屑，常伴有系统性病变。硬化性苔藓表现为包茎、色素减退的包皮或阴茎头，呈纸莎草状质地。血管角皮瘤通常无症状，界限清楚，呈红色或蓝色丘疹，而苔藓样糠疹通常产生无症状的针头大小、色素减退的丘疹。扁平苔藓的病变是瘙痒、紫红色、多边形丘疹，通常是系统性的。如果患者的阴茎头或包皮有天鹅绒般红色或角化斑块，则应怀疑原位癌，而浸润性鳞状细胞癌则表现为无痛性肿块、溃疡或外生不规则肿块。一些良性病变，如银屑病和扁平苔藓，可能会模仿原位癌或鳞状细胞癌。如果诊断有疑问或不能排除肿瘤，应进行活检。良性阴茎病变的治疗通常包括观察或局部皮质类固醇；然而，肿瘤性病变通常需要手术。
