Intravesical Bacillus Calmette-Guérin (BCG) related complications are known to present in a myriad of forms. We report an unusual presentation of subcutaneous penile nodules without balanitis or glans ulceration with concomitant granulomatous prostatitis following the induction course of BCG for bladder cancer. Levels of evidence are not applicable.

Secondary penile involvement in anorectal carcinoma represents an uncommon manifestation of advanced metastatic disease, with few cases documented in the literature. Despite the rich vascular and lymphatic supply of penile tissue, penile metastases arise predominantly from genitourinary primaries; an anorectal origin is exceptionally rare and is generally associated with poor oncologic outcomes. We report the case of a middle-aged man with T4N2M1 anorectal squamous cell carcinoma (SCC) and synchronous hepatic metastases who developed a painful ulcerative lesion and a firm subcutaneous nodule along the lateral penile shaft during concurrent chemoradiotherapy. Doppler ultrasonography identified a 1.4 × 1.4 cm hyperechoic, hypervascular lesion. Pelvic magnetic resonance imaging demonstrated multiple hypoenhancing lesions involving the corpora cavernosa, corpus spongiosum, and penile crura. Histopathological examination confirmed metastatic SCC with immunophenotypic concordance with the anorectal primary tumor. A multidisciplinary board recommended radical penectomy with perineal urinary diversion; however, due to rapid systemic disease progression and declining performance status, the patient transitioned to best supportive care. Penile metastasis from anorectal carcinoma typically presents as a metachronous event and is indicative of widespread systemic dissemination with a guarded prognosis. Diagnosis is established through histopathological confirmation, supported by cross-sectional imaging to define the anatomical extent of disease. Treatment is primarily palliative and requires individualized multidisciplinary assessment that integrates disease burden, functional status, and patient-centered goals of care. Awareness of this rare metastatic pattern among clinicians managing pelvic malignancies is essential to facilitate prompt diagnostic evaluation and appropriate goals-of-care discussions.

Chemsex involves the use of psychoactive substances to facilitate or enhance sexual activity, particularly among gay, bisexual, and other men who have sex with men (GBMSM). Common substances used include methamphetamine, gamma-hydroxybutyric acid/gamma-butyrolactone (GHB/GBL), mephedrone, ketamine, inhaled nitrites ('poppers'), and cocaine, all of which are linked to various dermatological complications. Dermatologists are often the first to recognize skin and mucosal manifestations in chemsex users, providing an opportunity for timely intervention and risk reduction. A targeted literature search until January 2026 was conducted using PubMed/MEDLINE to identify relevant publications on chemsex-associated dermatological manifestations. The studies included were observational, case series, case reports and clinical guidelines, focusing on the clinical presentation, substances involved and routes of administration. Cutaneous and mucosal lesions vary depending on the substance and route of administration. Poppers dermatitis, commonly seen in GBMSM, is a well-defined manifestation and often misdiagnosed as impetigo. 3,4-Methylenedioxymethamphetamine (MDMA), often used in chemsex, leads to oral mucositis and painful aphthous-like ulcers due to its acute effects, such as bruxism and xerostomia. Injection-related lesions from substances like mephedrone and ketamine are particularly concerning, often resembling infectious or vasculitic processes and frequently leading to delayed diagnoses. Cocaine use, especially when combined with levamisole, can cause cutaneous necrosis, vasculitis and soft tissue infections. GHB/GBL use may cause traumatic genital and perianal injuries due to reduced pain sensitivity, while alprostadil injections can result in localized oedema, haematomas or fibrosis. Lastly, constricting devices used in chemsex settings can lead to mechanical trauma, ischaemic injury and chronic complications like fibrosis and penile deformities. Chemsex is a significant public health concern with dermatological implications. Improved awareness of characteristic cutaneous and mucosal lesions can support earlier recognition, targeted investigation and non-stigmatizing risk-reduction advice and referral. More prospective studies and standardized diagnostic criteria are needed to enhance the management of chemsex-related dermatological and systemic complications.

Intravascular papillary endothelial hyperplasia (IPEH), or Masson's tumor, is a rare benign vascular lesion, seldom described in the genital region. We report a 20-year-old male presenting with a painless penile ulcer initially mistaken for a sexually transmitted infection. Histopathology showed characteristic papillary endothelial proliferation within vessel lumina, with no atypia. Complete excision led to a favorable outcome with no recurrence. This report emphasizes IPEH as an important mimic of genital ulcer disease.

Pyoderma gangrenosum is a non-bacterial inflammatory disease that forms ulcers and abscesses and can be exacerbated by mechanical stimulation. Surgical intervention for abscesses in the corpora cavernosa may exacerbate penile pyoderma gangrenosum. We report a case of penile pyoderma gangrenosum that was diagnosed minimally invasively by biopsy alone and treated with steroids. A 77-year-old man with penile swelling and pain was referred to our institution by his primary care physician for suspected penile cancer. Both infectious diseases and penile cancer were ruled out based on physical examination and laboratory test results. Magnetic resonance imaging revealed fluid accumulation in the corpora cavernosa, leading to the decision to perform a penile biopsy. The biopsy revealed no malignancy, but an abscess was identified. Based on the clinical presentation, penile pyoderma gangrenosum was suspected and steroid therapy was initiated, resulting in rapid symptomatic improvement. The steroid dose was gradually tapered, and after 18 months of treatment, the steroids were discontinued. The patient has remained asymptomatic with no recurrence of the abscess or other subjective complaints.

A 30-year-old man with recent diagnosis of HIV-infection was seen in the hospital, because of a 1-month history of swollen lips, painful oral mucosa ulcers, cervical lymph nodes and skin lesions. The medical history showed a previous patient contact with 10 subjects, with positivity for Monkeypox virus in 8 subjects. A week later, he began with lesions on the genitals, managed with acyclovir, and subsequent development of manifestations in the mouth and skin, with dissemination to the entire body. He was admitted to our clinic for increased volume in penis and scrotum, and a disseminated dermatosis affecting all body segments, characterized by polymorphic lesions reflecting various stages; the condition presents as infiltrated plaques with a central eschar and two halos at the periphery: one pale and another erythematous, of varying sizes, accompanied by significant edema (Figure 1A). In the mouth there was lip edema, with the presence of multiple superficial round ulcers and vesicles, with a hemorrhagic center and a white-yellowish border, that coalesce forming circinate plaques, with serohematic crusts on the upper vermilion and hematic and meliceric crusts on the lower one, as well as pale mucosa (Figure 1B). Intraorally, painful large shallow ulcers, covered with fibrin and hemorrhagic areas, with rounded and irregular edges, affected both labial mucous membranes, the hard palate and gums, with gingival enlargement and necrosis of the interdental papillae (Figure 1C); the tongue showed partial atrophy of filiform papillae with some isolated punctiform ulcers. A presumptive diagnosis of Monkeypox infection was suggested. Biopsies on lower labial mucosa and plantar skin were performed. Analysis of blood test revealed: hemoglobin 10.8 (13.1 - 18.1) g/dL, iron 22 µg/dL (50 - 212), ferritin 2362 (23 - 336,2) ng/mL, leukocytes 10.8 (3.9 - 10.1)/mm3, aspartate aminotransferase 47.3 (13 - 39) U/L, albumin 2.4 (3.5 - 5.7) g/dL, CD4 count 121 (500-1500) cells/mm3 and HIV-viral load 312,000 (<20-75) copies/mL, starting antiretroviral therapy with bictegravir/emtricitabine/tenofovir alafenamide (biktarvy) and management with antibacterials and antivirals. The histopathological study of lesions was compatible with monkeypox infection and PCR test for the monkeypox virus confirmed the diagnosis (1,2). The patient had increased difficulty in swallowing, first with solids then with liquids; and, given the risk of airway obstruction due to oropharyngeal edema, a tracheostomy was performed. Disease progression was observed, with kidney damage and pulmonary dysfunction, and he died a month later. Mucocutaneous and other clinical features such as fever, chills, headache, muscular pains, backaches, and weariness, are some of the first symptoms of a Monkeypox infection.(2-5) A gradual maculopapular rash with lesion diameters ranging from 0.2-1 cm appears after the prodrome stage; initially on the face and neck, and moving to the legs with involvement of the palms and soles, spreading throughout the body.(2, 5) These last characteristics favored the initial diagnosis of a Monkeypox infection in our patient. Differential diagnosis should include other pox-like viruses, such as varicella, herpes zoster, measles, and arboviruses (Dengue, Zika and chikungunya). (2) This case represents a rare situation where the host rapidly developed progressive worsening of Monkeypox manifestations in HIV-infection.

Squamous cell carcinoma of the glans is a rare malignancy, often diagnosed at an advanced stage, and its management remains challenging. Therapeutic approaches are multimodal and depend on tumor stage, risk of recurrence, nodal involvement, and disease extent. Organ-preserving strategies are increasingly advocated, particularly in patients who refuse mutilating surgery. We report the first Moroccan case of a 50-year-old man diagnosed with a T2N0M0 glans carcinoma, treated with high-dose-rate (HDR) brachytherapy using a customized template following refusal of partial penectomy. Initial treatment achieved adequate tumor coverage without acute toxicity, with no evidence of necrosis or skin ulceration. A superficial recurrence in the previously irradiated area was detected four months later and was successfully treated with salvage HDR brachytherapy. At 18 months of follow-up, urinary function was preserved and partial sexual function maintained, with no severe complications. This case illustrates that personalized HDR brachytherapy may represent a feasible, safe, and organ-preserving alternative in patients refusing mutilating surgery, supporting its applicability even in resource-limited settings.