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Reflectance confocal microscopy confirmed histopathologic diagnoses of balanitis, carcinoma

Reflectance confocal microscopy accurately differentiated between balanitis and carcinoma in situ compared with standard histopathologic methods, according to study results.

In an observer-masked study, researchers evaluated 15 men (mean age, 65 years) with histopathologically confirmed balanitis or carcinoma in situ (CIS). The men had presented with atrophic to hyperkeratotic, red to brown lesions on the glans penis and/or inner aspect of prepuce. Clinical, histologic and reflectance confocal microscopy (RCM) findings were used for assessment. Surrounding, noninvolved skin was evaluated in five cases of balanitis. Local recurrence, nodal metastasis, disease-specific death and overall death were outcome measures.

Using digital photography, clinical imaging diagnosed six cases of CIS, seven cases of balanitis and two potentially malignant lesions. Histopathologic evaluation revealed three cases of CIS, six cases of Zoon plasma cell balanitis and six cases of nonspecific balanitis. The histopathologic diagnoses were confirmed by RCM evaluation when all lesions were imaged by a Vivascope 1500 (Lucid). Atypical honeycomb pattern and disarranged epidermal pattern/local loss were shown in all CIS cases. Nucleated honeycomb pattern was observed in 11 of 12 cases of balanitis; six cases showed typical honeycomb pattern. Vermicular vessels were observed, and scattered small bright cells in the upper dermis and round vessels were present in all balanitis cases. Typical honeycomb pattern was present in adjacent uninvolved skin.

“In general, genital skin is suitable for confocal microscopy because of its thin or absent cornified layer,” the researchers reported.

“We have shown some new aspects of the use of RCM on genital skin, as well as confirming previous findings,” the researchers concluded. “It is advantageous that uncomfortable and painful biopsies from the genital area may be avoided in some cases. At the moment, the applicability of this method of routine practice is restricted not only by the need for confirmatory studies but also because the Vivascope 1500 is available only at a few specialized centers.”