Dermoscopy may help monitor erythroplasia of Queyrat treatment elucidates case study

Use of dermoscopy to monitor treatment effect in erythroplasia of Queyrat was published recently in the Indian Journal of Dermatology, Venereology and Leprology.

A 52‑year‑old man presented with an erythematous plaque on the glans penis which had started as an asymptomatic plaque and had increased in size to involve the corona in the past one month. Dermoscopy revealed clustered glomerular blood vessels against a red background, some hairpin-like blood vessels, twisted blood vessels and small structureless red areas. Skin biopsy showed disorderly arrangement of atypical keratinocytes with pleomorphic nuclei with Ki‑67 positivity (70%) confirming the diagnosis of erythroplasia of Queyrat. Rest of the investigations were within normal limits.

Patient was treated with photodynamic therapy i.e. cotton soaked with 20% 5‑aminolevulinic acid solution kept over the lesions for 3 hours, extending 1 cm beyond the lesion. It was followed by irradiation using red light (635 nm, 80 mw/cm2) for 20 minutes. Treatments were repeated every 7‑10 days.

Dermoscopy was performed before each treatment session. At the 6th session, most of the skin lesions had disappeared but dermoscopy showed a few glomerular vessels. By the 13th session, the lesions had completely disappeared with dermoscopy showing almost no glomerular vessels and no subsequent treatment was administered. One year later clinical examination revealed brown pigmentation on the left side of glans. Dermoscopy showed light red background and a few brown globules without any obvious glomerular vessels. The second biopsy was done on February 28, 2019 which showed no abnormality.

Even after 6 sessions when the skin lesions had clinically resolved, glomerular vessels and structureless red areas were visible under the dermoscopy. Photodynamic therapy was continued till the abnormal vessels had completely disappeared which on histopathology corresponded to resolution of the lesion.

Thus dermoscopy could be useful in monitoring the treatment of erythroplasia of Queyrat and determining the endpoint of photodynamic therapy and could improve the accuracy of evaluation compared to clinical examination alone.

Source-

1. Wu M, Yang L, Li J, Zhao L. Dermoscopic monitoring of erythroplasia of Queyrat treated with photodynamic therapy. Indian J Dermatol Venereol Leprol. 2021 May-Jun;87(3):396-399. doi: 10.25259/IJDVL_89_20. PMID: 33871191.
2. Errichetti E. Dermoscopy in Monitoring and Predicting Therapeutic Response in General Dermatology (Non-Tumoral Dermatoses): An Up-To-Date Overview. Dermatol Ther (Heidelb). 2020 Dec;10(6):1199-1214. doi: 10.1007/s13555-020-00455-y. Epub 2020 Oct 8. PMID: 33030661; PMCID: PMC7649174.