penile growths part. 1

[albert22]

Hello Doctor,
Sorry if this may get a little long. I am a 22 year old circumcised male. In the beginning of January 2002 I had an episode with a female friend who I have since lost contact with. We did not have intercourse, but the underside of my penis was at times certainly touching her genital area. About five or six months ago I noticed approximately four or five very small bumps scattered across the top of my penis within the circumcision scar area which wraps around the shaft. They are very small, averaging about the size of a pencil tip or smaller, and some appear to be shaped slightly like a grain of rice. When my penis is limp these growths seem to be a natural parts of the skin folds and wrinkles, but when erect or stretched they stand up and become more apparent. When I stretch the skin vertically up the shaft they are virtually undetectable and appear more as lines of skin, but when stretched horizontally across then become more apparent to touch and sight. All are soft,and flesh colored - some mildly darker than others- and seem to have grown just slightly since I first noticed them six months ago. Again, when flaccid the bumps are undetectable and reduce to what seems to be natural skin folds. Some of the bumps appear to be just below the skin, as for others, especially the slightly darker ones, it is not easy to tell. When I examine the skin of the circumcision area where these bumps are confined the texture appears to be a bit keratinized and course. In the areas where the skin is most wrinkled are some small slightly pigmented circular patches, maybe fractions of a centimeter in width, which almost seem to be made up of very very tiny bumps or possibly just rough skin. Under both areas there are single veins close to the skin surface and I assume that this could be a possible cause of their slightly darker appearance. When flaccid, they reduce to what I think has always been the natural geography of my penis.
        So, I went to my primary care physician about two months ago. He was concerned with the possibility of warts, but after he applied the vinegar solution and observed no change he assured me that they were not. Later that week, not being totally confident in his diagnosis, I returned and ask to be referred to a dermatologist. While I was in his office he repeated the vinegar test which again came up negative.
        The Dermatologist whom I saw the following week did not seem to suspect warts but I am not sure if this was on account of the previous test results or on his own personal judgment. His clinical diagnosis seemed very vague and he used a term in his diagnosis that I can't remember, but that I had never encountered in my own research regarding normal conditions effecting male genitalia. I requested a biopsy exam to be done on two areas and the pathology report reveled, according to the doctor, normal skin. I asked if there was anything in the report that would indicate a condition related to some kind Keratosis and he said no, that it was just normal skin. His assessment was not very reassuring and I imagined that he could have provided me with more specific information, both in the clinical exam and in interpreting the pathology report. I find it hard to believe that the pathologist found absolutely no defining characteristic that could indicate the cause of the growths.
         A few weeks later I went to see a second dermatologist who was a little more reassuring in his clinical exam. He said that basically he sees "many, many cases of warts and these are just normal overgrowths of skin". He then brought it to my attention that theses  bumps are confined specifically to the area where my foreskin was removed and the skin now bunches together, already having a slightly rough texture when stretched out. He advised me not to have second biopsy and I left feeling a little more assured. Now I am not.
       I keep going over every aspect of this situation I can not connect the dots. I feel like some of the physicians I have been seeing either do not have experience in this area or are basing their diagnosis primarily on information provided by the previous practitioner. In my searching I cannot find any particular condition that seems be to consistent with what I have and would also be pathologically described as "normal skin", with nothing else worth mentioning. I have decided to see another Dermatologist for another biopsy, and am wondering what conditions I may need to be concerned with which could be pathologically ambiguous or may be confused or possibly related to HPV. And, based on what pathological finding should I request to have more precise diagnostic methods employed such as DNA testing.
       If you could give me your thoughts about the information above I would really appreciate it.This would be a tremendous help for me and make me feel more confident at my next visit to the clinic. Also, if you could recommend of a Dermatologist or clinic in the NYC area that has good experience or even specializes in these areas it would be incredible.

Thanks for your time,    
Albert

[Alan Rockoff, MD]

Given your description, I'm not at all sure why you're almost completely sure.

Please let the dermatologist make the evaluation, with biopsy confirmation if needed.

Dr. Rockoff

[albert22]

doctor,
i am almost completely sure that i have seborrheic keratosis. if my dermatologist says that hpv and sk are not related what should i do.
thanks,
albert

[albert22]

Hello Doc,
Yes, I certainly can see how I may be over reacting. I am out of the country and when I return I will definitely take a milder course of action like you have suggested. But simply for my comfort at the moment, could you tell me if it is possible for cysts to form in the the circumcision scar line in the way I have described? I really appreciate it.
-Albert

[Alan Rockoff, MD]

As a matter of fact, yes--small, white inclusion cysts often form in scar lines.

Take care.

Dr. Rockoff

[Alan Rockoff, MD]

You have been to two dermatologists.  You have had a skin biopsy.  The biopsy showed normal skin.  The dermatolkogist told you this.  And your response is, "His assessment was not very reassuring and I imagined that he could have provided me with more specific information, both in the clinical exam and in interpreting the pathology report."

What, may I ask, is vague and nonspecific about saying that the biopsy showed normal skin?  What could he--or anyone--possibly say that would convince you that you don't have anything worng?

I am not sure there is an answer to my question, but I would not recommend another biopsy.  I suggest instead that you consult one of the dermatologists at NYU or Columbia-Mt. Sinai (for instance), have the biopsy report already done forwarded to them--and be prepared to be told that you have nothing wrong.

Best.

Dr. Rockoff