This article is more than 5 years old. Information may no longer be current.
A sexually active adolescent with penile lesion
Click Here to Manage Email Alerts
A 16-year-old male presents for evaluation of yellowish-white papules on the penis. The lesion was first noted 2 months ago, and it is asymptomatic. The patient does not note any drainage or bleeding from this area. He does not have similar lesions on any other part of his body. He is sexually active with one partner and only occasionally uses condoms. The patient is otherwise in good health.
On physical exam, the patient is noted to have several midline 3-mm to 5-mm yellowish-white mobile papules on the ventral surface of the penis with some surrounding erythema. No central punctum or umbilication are noted.
Shehla Admani
Andrew C. Krakowski
How could these lesions have been prevented?
A. Abstinence
B. Cleansing with antibacterial soap
C. Administration of the HPV vaccine
D. Consistent use of condoms
E. They could not have been prevented; they are the result of a congenital defect
Can you spot the rash?
Median raphe cyst
Case Discussion
In an adolescent male who is sexually active, the differential diagnosis of a penile lesion should include molluscum contagiosum, condyloma acuminata and folliculitis. The clinical appearance of this lesion does not fit any of the previously mentioned diagnoses; however, the one clue to the diagnosis is the midline nature of the lesion.
Yellowish-white papules on the ventral surface of the penis.
Source: Krakowski AC
Median raphe cysts are rare and thought to be caused by a congenital defect (Answer E) in the embryologic development of the male genitalia, specifically the urethral folds. They are most commonly found on the ventral aspect of the penis; however, they can occur anywhere from the urethral meatus to the anus. Most are present from birth and remain undetectable until adolescence or adulthood, at which time they present as a solitary, freely movable midline papule or nodule. These cysts are generally asymptomatic and do not interfere with urinary or sexual function.
Median raphe cysts are dermal in nature and do not have underlying connections to the urethra. Treatment of choice is simple excision followed by primary closure.
Asarch RG. Arch Dermatol. 1979;115:1084-1086.
Golitz LE. Cutis. 1981;27:170-172.
Nagore E. Pediatr Dermatol. 1998;15:191-193.
For more information:
Shehla Admani, MD, is a clinical research fellow in pediatric dermatology at Rady Children’s Hospital, San Diego. She can be reached at 8010 Frost St., Suite 602, San Diego, CA 92123; email: sadmani@rchsd.org.
Andrew C. Krakowski, MD, is an attending physician at Rady Children’s Hospital, San Diego.
Disclosure: Admani and Krakowski report no relevant financial disclosures.