Penile Intraepithelial Neoplasia: Successful Treatment with Topical 5% Imiquimod Cream

Open access


The authors present a case of a 36-year-old man with a penile intraepithelial neoplasia who was evaluated at the Outpatient Clinic of the Department of Dermatovenereology Diseases of the Clinical Center of Vojvodina in December of 2010. The patient was referred to this facility by an urologist and had histopathological reports of 4 biopsy specimens taken from different plaques on the glans penis. Biopsy samples were collected from lesions which were clinically diagnosed as leukoplakia. Histopathological findings of all biopsy specimens showed: “dysplasio epithelii planocellularis gradus levioris et partim gradus mediocris diffusa”. Given the histopathological diagnosis, the patient was referred to a dermatologist for conservative therapy of these lesions, avoiding radical surgery. On admission, the patient presented with slightly indurated erythematous plaques with some desquamation at the surface, and a tendency for diffuse involvement of the entire glans penis. Topical 5% imiquimod cream was administered on the lesions once a day and was washed off after 8 hours during 10 weeks. Check-ups were scheduled for every other week in order to assess the course and progress of topical treatment. No significant side effects were recorded, except for acute local inflammation accompanied by mild exudation and itching. After 10 weeks of treatment, complete regression of lesions was achieved, and in the following period of 18 months (until present) no recurrence was observed.

1. Aynaud O, Ionesco M, Barrasso R. Penile intraepithelial neoplasia: specific clinical features correlate with histologic and virologic findings. Cancer 1994;74(6):1762-7.

2. Cubilla A, Dilliner J, Schellhammer PF, Horenblas S, Ayala AG, Reuter VA, et al. Malignant epithelial tumors. In: Eble NJ, Sauter G, Epstein IJ, Sesterhenn IA. World Health organization classification of tumours: pathology and genetics of tumors of the urinary system and male genital tumors. Lyon: IARC Press; 2004. p. 281-90.

3. Bunker CB, Neill SM. The genital, perianal and umbilical regions. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook’s textbook of dermatology. 6th ed. Oxford: Blackwell Publishing Ltd; 2010. p. 71.1-102.

4. Wikström A, Hedblad A, Syrjänen S. Penile intraepithelial neoplasia: histopathological evaluation, HPV typing, clinical presentation and treatment. J Eur Acad Dermatol Venereol 2012;26:325-30.

5. Cubilla AL, Velazques EF, Reuter VE, Oliva E, Mihm MC, Young RH. Warty (condylomatous) squamous cell carcinoma of the penis: a report of 11 cases and proposed classification of ‘verruciform’ penile tumors. Am J Surg Pathol 2000;24:505-12.

6. Cubilla AL, Velazquez EF, Young RH. Epithelial lesions associated with invasive penile squamous cell carcinoma: a pathologic study of 288 cases. Int J Surg Pathol 2004;12(4):351-64.

7. Wagstaff AJ, Perry CM. Topical imiquimod: a review of its use in the management of anogenital warts, actinic keratoses, basal cell carcinoma and other skin lesions. Drugs 2007;67(15):2187-210.

8. Berth-Jones J. Topical treatment. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook’s textbook of dermatology. 6th ed. Oxford: Blackwell Publishing Ltd; 2010. p. 73.1-52.

9. McLaughlin PJ, Rogosnitzky M, Zagon IS. Inhibition of DNA synthesis in mouse epidermis by topical imiquimod is dependent on opioid receptors. Exp Biol Med 2010;235:1292-9.

10. Gaspari A, Tyring SK, Rosen T. Beyond a decade of 5% imiquimod topical therapy. J Drugs Dermatol 2009;8(5):467-74.

11. Rivers JK, Rosoph L, Provost N, Bissonnette R. Open-label study to assess the safety and efficacy of imiquimod 5% cream applied once daily three times per week in cycles for treatment of actinic keratoses on the head. J Cutan Med Surg 2008;12:97-101.

12. Choi JW, Choi M, Cho KH. A case of erythroplasia of queyrat treated with imiquimod 5% cream and excision. Ann Dermatol 2009;21(4):419-22.

13. Wigbels B, Luger T, Metze D. Imiquimod: a new treatment possibility in bowenoid papulosis? Hautarzt 2001;52(2):128-31.

14. Bhatia N. Imiquimod as a possible treatment for keratoacanthoma. J Drugs Dermatol 2004;3(1):71-4.

15. Diaz-Arrastia C, Arany I, Robazetti SC, Dinh TV, Gatalica Z, Hannigan E. Clinical and molecular responses in high grade intraepithelial neoplasia treated with topical imiquimod 5%. Clin Cancer Res 2001;7:3031-3.

16. Todd RW, Etherington IJ, Luesley DM. The effects of 5% imiquimod cream on highgrade vulval intraepithelial neoplasia. Gynecol Oncol 2002;85:67-70.

17. Porter WM, Francis N, Hawkins D, Dinneen M, Bunker CB. Penile intraepithelial neoplasia: clinical spectrum and treatment of 35 cases. Br J Dermatol 2002;147:1159-65.

18. Stockfleth E, Meyer T, Benninghoff B, Salasche S, Papadopoulos L, Ulrich C, et al. A randomized, double-blind, vehicle controlled study to assess 5% imiquimod cream for the treatment of multiple actinic keratoses. Arch Dermatol 2002;138:1498-502.

19. MacKenzie-Wood A, Kossard S, de Launey J. Imiquimod 5% cream in the treatment of Bowen’s disease. J Am Acad Dermatol 2001;44:462-70.

20. Smith KJ, Germain M, Yeager J, Skelton H. Topical 5% imiquimod for the therapy of actinic cheilitis. J Am Acad Dermatol 2002;47:497-501.

21. Marks R, Gebauer K, Shumack S, Amies M, Bryden J, Fox TL, et al. Imiquimod 5% cream in the treatment of superficial basal cell carcinoma: results of a multicentre 6 week doseresponse trial. J Am Acad Dermatol 2001;44:807-13. 22 Geisse J, Rich P, Pandya A, Gross K, Andres K, Ginkel A, et al. Imiquimod 5% cream for the treatment of superficial basal cell carcinoma: a double-blind randomized vehicle-controlled study. J Am Acad Dermatol 2002;47:390-8.

23. Jaleel H, Narouz N, Wade AA, Allan PS. Penile intraepithelial neoplasia: a veiled lesion in genitourinary medicine. Sex Transm Infect 1999;75:435-6.

24. Perras C. Imiquimod 5% cream for actinic keratosis. Issues Emerg Health Technol 2004;(61):1-4.

25. Kreuter A, Brockmeyer NH, Weissenborn SJ, Gambichler T, Stücker M, Altmeyer P, et al. Penile intraepithelial neoplasia is frequent in HIV-positive men with anal dysplasia. J Invest Dermatol 2008;128:2316-24.

Serbian Journal of Dermatology and Venereology

The Journal of Serbian Association of Dermatovenereologists (SAD)

Journal Information


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 140 140 18
PDF Downloads 45 45 7