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Resume Introduction Les neoplasies intra-epitheliales (NIE) du penis sont des lesions genitales definies sur le plan histologique par la presence d’atypies cytologiques et architecturales intra-epitheliales et pouvant evoluer vers un carcinome epidermoide invasif. Methode Une revue de la litterature portant sur la classification, la description clinique et la prise en charge des NIE a ete realisee en considerant les articles traitant des NIE du penis, repertories sur la base de donnee Medline entre octobre 2007 et octobre 2017, a l’aide des mots cles « intraepithelial neoplasia » ou « Bowen's disease » ou « erythroplasia of Queyrat » ou « bowenoid papulosis » et « penis ». Les articles ont ete selectionnes selon leur langue de publication (anglais et francais) et la pertinence par rapport au sujet. Resultats Cent-soixante-quatorze articles relatifs aux NIE du penis ont ete repertories, dont vingt-cinq ont ete selectionnes pour leur pertinence. L’analyse bibliographique de ces vingt-cinq articles a identifie six articles d’interet anterieurs en octobre 2007, qui ont ete pris en compte dans cette revue systematique, totalisant ainsi trente et un articles. Nous decrivons les NIE du penis en precisant leurs aspects cliniques et histologiques ainsi que leur prise en charge. Conclusion L’urologue, en collaboration avec l’anatomopathologiste, doit savoir distinguer les NIE bowenoides HPV-induites des NIE differenciees non HPV-induites, cliniquement proches, mais differentes sur le plan histologique et therapeutique.

Penile intra-epithelial neoplasia (PIN) are precancerous lesions, characterized by architectural and cytological abnormalities of the genital epithelium, from which can arise squamous carcinomas.A literature review was performed on the Medline database, considering the articles listed between October 2007 and October 2017 dealing with PIN, using the following keywords "intraepithelial neoplasia" or "Bowen's disease" or "erythroplasia of Queyrat" or "bowenoid papulosis" and "penis ». Papers were selected according to their language (English and French) and their relevance.One hundred seventy four articles related to PIN were listed. Twenty-five of them were selected for their relevance. The analysis of the references of these articles identified 6 relevant papers published before October 2007, which were considered for this review based on a total of thirty-one articles. We describe clinical and pathological characteristics of PIN, emphasizing treatment modalities.Urologists should distinguish HPV-related and non HPV-related PIN, both of them sharing clinical presentation, but needing different management.

Resume Introduction Le recours a la biopsie cutaneomuqueuse est parfois necessaire pour etablir le diagnostic histologique d’une dermatose penienne, notamment en cas de doute clinique ou pour affirmer la nature maligne d’une tumeur. Nous avons etudie la rentabilite de ce geste en evaluant la correlation entre le diagnostic clinique suspecte et le diagnostic histologique finalement retenu. Patients et methode Il s’agit d’une etude monocentrique retrospective portant sur les dossiers d’hommes ayant presente une dermatose penienne biopsiee entre juin 2006 et juin 2011. Ont ete colliges : l’âge, le site de la biopsie, les hypotheses diagnostiques cliniques et le diagnostic histologique finalement retenu, afin de determiner la concordance entre les hypotheses diagnostiques cliniques et histologiques. Resultats Les dossiers de 138 hommes d’âge moyen 52 ans ont ete revus. La majorite des biopsies (41 %) avaient ete realisees au niveau du gland. L’examen histologique des biopsies n’a pas permis de poser un diagnostic dans 20 cas (14,5 %). Cet examen histologique a confirme le diagnostic suspecte cliniquement dans 29,7 % des cas et a permis de conclure a un diagnostic parmi plusieurs hypotheses cliniques dans 26,8 % des cas. Au contraire, le diagnostic histologique n’avait pas ete suspecte cliniquement dans 18,1 % des cas et aucune hypothese diagnostique clinique n’avait ete formulee dans 10,9 % des cas. La concordance entre les diagnostics cliniques proposes et le diagnostic histologique retenu etait de 63,4 %. Discussion La biopsie cutaneomuqueuse constitue un acte souvent necessaire dans la prise en charge des dermatoses genitales de l’homme, puisqu’elle permet dans 44,9 %, soit de porter un diagnostic non suspecte cliniquement, soit de trancher entre plusieurs hypotheses cliniques.

Resume Introduction La maladie de Paget extramammaire (MPEM) est actuellement consideree comme un adenocarcinome in situ d’evolution lente. Son association avec un adenocarcinome invasif sous-jacent est beaucoup plus rare que pour les localisations mammaires, ou cette association est quasi constante. Cependant, une evolution invasive est a craindre lorsque la MPEM evolue depuis plusieurs annees. Observation Un homme de 59 ans consultait pour prise en charge d’une maladie de Paget du scrotum evoluant depuis plus de 15 ans et traitee par de simples topiques emollients. Deux zones infiltrees etaient apparues recemment et leur exerese avait permis de porter le diagnostic de maladie de Paget invasives a ces deux niveaux. Une evolution metastatique survenait dix mois plus tard, entrainant rapidement le deces du patient. Discussion La MPEM non invasive etait consideree jusqu’a present comme une affection peu agressive du fait de son evolution lente. Elle se caracterise par un risque important de recidive apres exerese chirurgicale, quelle que soit la marge d’exerese. Malgre un bon pronostic au stade intraepithelial, l’augmentation de la duree de vie de la population rend possible une evolution invasive ou l’apparition d’un adenocarcinome sous-jacent et il n’est plus possible de negliger la prise en charge de cette affection. A la lumiere de ce cas clinique, un renforcement de cette prise en charge semble souhaitable des le stade intraepithelial.

Squamous cell carcinomas of the oral cavity and lips consistently have a high incidence (they constitute the fifth most common form of cancer in France) and carry a heavy prognosis, particularly if diagnosed late. According to different studies, between 10 and 80% of such carcinomas occur in a pre-existing or precancerous lesion. The World Health Organisation (WHO) recommends the use of two terms for such lesions: precursor lesions, i.e. histological lesions associated with intraepithelial neoplasia (IEN) and verrucous hyperplasia (VH), frequently resulting clinically in leukoplakia or erythroplakia; "at risk" lesions, which include lichen planus, submucosal oral fibrosis and certain forms of genodermatosis.

Penile biopsy can be useful to establish an accurate diagnosis when managing male genital dermatoses. We investigated the value of genital biopsy by comparing suspected clinical diagnosis with final histologic diagnosis.We retrospectively examined the clinical file of men with genital dermatoses undergoing genital biopsy. We collected details of age, biopsy site, suspected diagnosis after clinical examination and histologic diagnosis.One hundred and thirty-eight male patients were enrolled in the study. Their mean age was 52 years. Most biopsies (41%) were performed on the glans. Microscopic examination failed to rule out a diagnosis in 14.5% of the cases. It confirmed the clinically suspected diagnosis in 29.7% of cases and ruled out a particular diagnosis from among several clinical hypotheses in 26.8% of cases. The histological diagnosis had not been suspected in 18.1% of cases.Penile biopsy has an important role in the diagnosis of penile dermatoses. In our study, in 44.9% of cases, a clinically unsuspected diagnosis was identified or a differential diagnosis was resolved.

Extra-mammary Paget's disease (EMPD) is currently considered a slowly progressing in situ adenocarcinoma. It is much more rarely associated with an invasive underlying adenocarcinoma than in mammary sites, where this association is almost always seen. However, an invasive course is to be feared where EMPD has been progressing for several years.A 59-year-old man consulted for treatment of scrotal Paget's disease present for over 15 years and treated with topical emollients alone. Two infiltrated areas had recently appeared and their excision led to a diagnosis of invasive Paget's disease at these two points. Metastasis occurred 10 months later and rapidly proved fatal.Until now, non-invasive EMPD has been considered a fairly non-aggressive disease due to its indolent progression. However, it is characterised by considerable risk of relapse following surgical excision, regardless of the surgical margin. Despite a good prognosis at the intraepithelial stage, the rising life expectancy of the population means a greater likelihood of an invasive course or of the appearance of an underlying adenocarcinoma, and management of this condition can thus no longer be neglected. The present clinical case underscores the need for closer surveillance of the disease as of the intraepithelial stage.

Background The treatment of stage I Merkel cell carcinoma (MCC) usually includes wide local excision (WLE) combined with irradiation of the tumor bed (ITB). No randomized study has ever been conducted in MCC. The purpose of this study was to assess the efficacy and safety of prophylactic adjuvant radiotherapy on the regional nodes. Patients and methods In this randomized open controlled study, patients for a stage I MCC treated by WLE and ITB were randomly assigned to regional adjuvant radiotherapy versus observation. Overall survival (OS) and probability of regional recurrence (PRR) were primary end points. Progression-free survival (PFS) and tolerance of irradiation were secondary end points. Results Eighty-three patients were included before premature interruption of the trial, due to a drop in the recruitment mainly due to the introduction of the sentinel node dissection in the management of MCC. No significant improvement in OS (P = 0.989) or PFS (P = 0.4) could be demonstrated after regional irradiation, which, however, significantly reduced the PRR (P = 0.007) with 16.7% regional recurrence rate in the observation arm versus 0% in the treatment arm. The treatment was well tolerated. Conclusion The adjuvant regional irradiation significantly decreased the PRR in MCC, but benefit in survival could not be demonstrated.