zoon 's balanitis or balanitis circumscripta plasmacellularis is a benign chronic disease of unknown origin .
zoon 's balanitis , unlike some other inflammatory penile dermatoses , is generally not thought to be a precursor for neoplasia .
we herein report the case of an uncircumcised man , who developed clinically and histopathologically evident squamous cell carcinoma of the penis in an area affected by zoon 's balanitis .
a 71-year - old uncircumcised man presented with a 3-month history of extremely painful genital sores associated with swollen foreskin and dysuria , not preceded by any flu - like symptoms .
the patient reported that he has suffered from zoon 's balanitis for 12 years , confirmed by a histopathological examination .
he treated the condition with topical corticosteroids with relative improvement and paid periodic visits for 7 years ; after that he stopped performing any follow - ups .
clinical examination revealed a well - demarcated , highly indurated , glistening erythematous plaque ( about 3 cm in diameter ) on the glans and adjacent preputial mucosa .
a 3-mm punch biopsy of the glans was performed showing typical features of a moderately differentiated squamous cell carcinoma ( nests of atypical cells with abundant eosinophilic cytoplasm and large vesicular nucleus ) ( fig .
zoon 's balanitis is characterized by a solitary red - orange plaque of the glans and prepuce .
although the etiology is unknown , different factors have been reported to be involved in its genesis ( local infections , poor hygiene , heat , friction , and constant rubbing ) .
histopathologic examination demonstrate an inflammatory infiltrate of predominantly plasma cells , atrophy of epidermis , spongiosis , tortuous dermal blood vessels , and exocytosis of inflammatory cells [ 2 , 3 ] .
it is generally considered to be a benign condition , and its association with malignancies has been rarely reported . in 1999
, a case of penis carcinoma arising in a patient with zoon 's balanitis was described by joshi , implying that this inflammatory lesion could be a premalignant condition or could contribute to the development of squamous cell carcinoma .
after this report , the hypothesis that zoon 's balanitis may be followed by penile carcinoma or premalignant lesions started to arise . in 2001
, bunker claimed that there were zoonoid changes in clinical and histological features in some cases of lichen sclerosus , lichen planus , bowenoid papulosis and penile cancer .
these zoonoid changes could suggest that zoon 's balanitis per se is a premalignant condition .
recently , starritt and lee reported a case of erythroplasia of queyrat of the glans on a background of zoon 's plasma cell balanitis .
the hypothesis of the possible association between zoon 's balanitis and penile cancer could also be linked to the concept of inflammation as a cofactor in carcinogenesis . in 1863 , virchow noted a connection between inflammation and cancer and sustained that this link may have implications for cancer prevention and treatment .
therefore , prevention of penis carcinoma is possible , including early detection and relative treatment of risk factors ( phimosis , inflammatory conditions , multiple sexual partners , and hpv infections ) and precancerous lesions [ 9 , 10 ] .
this case highlights the importance of frequent follow - ups for zoon 's balanitis ; topical treatment , such as corticosteroids and calcineurin inhibitors [ 4 , 5 , 7 ] , may be important to prevent the development of a secondary carcinoma . in case of resistance to topical treatments ,
circumcision should be recommended because it could be curative and also protective against penile carcinoma .
 zoon 's balanitis or balanitis circumscripta plasmacellularis is a chronic disease of unknown origin . 
 this condition usually manifests in middle - aged or elderly uncircumcised men . although of unknown etiology 
 , different factors have been reported to be involved in its genesis ( local infections , poor hygiene , heat , friction , and constant rubbing ) . 
 it is generally considered to be a benign condition , and its association with malignancies has been rarely reported . 
 we report the case of an uncircumcised man , who developed clinically and histopathologically evident squamous cell carcinoma of the penis in an area affected by zoon 's balanitis . 
Introduction
Case Report
Discussion