How to cite: Kim GY. Penile Lesions: Dermatology Below the Belt. Grand Rounds in Urology. March 2025. Accessed Oct 2026. https://grandroundsinurology.com/penile-lesions-dermatology-below-the-belt/
Summary
Grace Y. Kim, MD, Assistant Professor, Dermatology, University of California, San Diego, San Diego, California, presents a case-based review of dermatologic conditions affecting the genital region, emphasizing pattern recognition and appropriate referral to dermatology.
Dr. Kim organizes genital dermatologic conditions into three broad categories: inflammatory, infectious, and premalignant or malignant. She highlights that accurate visual recognition and early differentiation between lesions and rashes are essential, particularly given long wait times for dermatology consultation.
Malignant and premalignant conditions include squamous cell carcinoma, verrucous carcinoma, and extramammary Paget disease. Squamous cell carcinoma may present as an erythematous, verrucous plaque and requires biopsy and surgical referral. Verrucous carcinoma is a subtype of squamous cell carcinoma that may resemble condyloma but requires excisional biopsy and should be avoided with radiation. Extramammary Paget disease presents as poorly defined erythematous plaques resembling eczema and requires biopsy and malignancy evaluation.
Infectious conditions include condyloma acuminatum and molluscum contagiosum. Condyloma presents as verrucous papules or plaques associated with human papillomavirus and may be treated with cryotherapy or topical agents. Molluscum contagiosum presents as umbilicated papules caused by poxvirus and is more common in immunosuppressed individuals.
Inflammatory conditions include balanitis, lichen planus, inverse psoriasis, lichen sclerosus, and pemphigus vegetans. These conditions vary in morphology but often require clinical recognition and targeted therapy. Lichen sclerosus carries a risk of progression to squamous cell carcinoma and requires treatment with high-potency topical steroids.
Dr. Kim emphasizes the importance of biopsy technique, including lesional and perilesional sampling for inflammatory conditions, and highlights the need for multidisciplinary management in complex cases.
She stresses that early recognition, appropriate initial management, and timely referral are critical in improving outcomes for patients with genital dermatologic conditions.
About the UCSD Urology Symposium for Primary Care Physicians & Advanced Practice Providers
The UCSD (University of California San Diego) Urology Symposium for Primary Care Physicians & Advanced Practice Providers conference brings together primary care physicians, advanced practice providers, and early-career urology clinicians who play pivotal roles in the urologic care continuum. It features topics such as benign prostatic hyperplasia, overactive bladder, kidney stones, sexual health, and urologic oncology. Through didactic lectures and interactive sessions that highlight the patient journey, the conference educates practitioners on guiding patients and their families toward the most appropriate therapies.
ABOUT THE AUTHOR
Grace Y. Kim, MD, is an Assistant Professor of Dermatology and a board-certified dermatologist at the University of California, San Diego, where she works closely with medical students and residents, providing training and mentorship. Dr. Kim's clinical and research interests focus on dermatopathology and women’s dermatology, including the treatment of conditions such as atopic dermatitis of pregnancy, extramammary Paget’s disease, vulvar dermatoses, breast dermatoses, and skin cancer screening.
