Treatment Course for (Mis)Diagnosis

[MH2056]

Hello.

I originally posted the below question on the Dermatology Community forum (go to link to see a picture), as a dermatology expert is not available: http://www.medhelp.org/posts/Dermatology/Treatment-Course-for-MisDiagnosis/show/1130063

This is a photo of a skin coloration on the base of my penis (the photo is a collage at various resolutions). The area is about 1/4" wide and high, is asymmetrical and brown in color. I first noticed this spot about 6-7 years ago (2002). Fifteen (15) months ago I showed my dermatologist, and upon clinical observation, he said "this has to be removed" and referred me to a urologist. I saw the urologist, and he viewed the spot as a non-threat but outlined a surgical procedure which I have not pursued.

Instead, I sought a second opinion from another dermatologist. This doctor said it looked like an "old wart" and he took a biopsy. The resulting diagnosis was a condyloma, but the second dermatologist mentioned "the pathologist had a difficult time identifying it". He prescribed Aldara, which has not had the desired effect to date (I'm 1/3 through the treatment).

I've since seen my regular (first) dermatologist and he inquired about the spot. Again, upon clinical observation, he stated "that is not a condyloma".

I'm looking for feedback on a course of treatment:

Should I get another biopsy?
Should I just get it surgically removed by a urologist?
As a urologist, what is your clinical observation or experience with a spot such as this?
Does it look like something other than a condyloma? Perhaps a melanoma in situ, seborrheic keratosis, or perhaps a bowenoid papulosis?

I know this is a dermatology question, but ultimately, I will need a urologist to remove this spot because the surgery is too complex for a dermatologist.

Thanks.

[MH2056]

Dr. Liroff,

Just wanted to provide an update to my ongoing treatment of this health concern. I had the surgery about 10 days ago. Everything went smoothly. Small incision, small scar, zero pain or discomfort.

I also recently received the pathology report, and the official diagnosis was Carcinoma in situ. Although I've known of this lesion for at least 7 years, the urologist said it was low-grade and not invasive. I guess Carcinoma in situ can be many things from Bowen's Disease to a more invasive squamous cell carcinoma. Either way, I will need to have another surgery to ensure all the material has been removed. This will likely follow with a trip to a dermatologist so I can be prescribed a topical therapy.

Any insights are welcome.

Best.

[PottyBreak]

I'm a 30yr old woman diagnosed with IC by my GYN a couple years ago. I've been taking the Elmiron as prescribed but it does not seem to be working. There's no pain, but very frequent urination and the constant feeling that my bladder is always full even right after I empty. I'm starting to get adverse side effects from the Elmiron (cramping, itching, insomnia and i'm willing to bet money it's effecting the sight in my left eye) I'm getting no where with my GYN. do you have any suggestions?

[Stephen Liroff, MD]

I am unaware of excision of a condyloma as a means of spread/recurrence. Anyway , your urologist will undoubtedly make it a point to cut around and not into the lesion. Note that your biopsy involved cutting into it.
Good decision.
S.A.Liroff, M.D.

[MH2056]

Dr. Liroff.

Thanks for your reply. I've decided to have the lesion surgically removed by a urologist, who stated this course of treatment as a best practice for any penile lesion. The downside of a malignancy (if formed) is too great.

If I could ask one follow up question: What is the likelihood that a condyloma can spread DUE to excision? My primary dermatologist, who was at first an alarmist about removing this lesion, has now changed his tune. Now he states it could spread post surgery if it is indeed a condyloma!! My urologist has assured me that is not an issue, and frankly, I've lost faith in my dermatologist. But, it is still unnerving when a doctor exlaims,"remove it or else!!" and then later says, "remove it and it could be big problems." Suffice to say, I'm switching dermatologists.

Any insights would be welcome.

Thanks.

[Stephen Liroff, MD]

No, the lesion that you show is not one that I would label "condyloma." Seeing as it has been biopsied, the slides can be referred to a dermatopathologist for a second opinion.
The removal of this appears to be a very simple, office type of procedure with minimal discomfort to follow and will provide more material to hopefully make a more definitive diagnosis if you just want to get rid of it all-together.
S.A.Liroff, M.D.