Penile metastasis from prostate adenocarcinoma is an exceptionally rare clinical finding, occurring in <0.3% of cases. We report an 85-year-old male with a history of Gleason 4+3 acinar adenocarcinoma, managed conservatively with long-term bicalutamide monotherapy because of his clinical stability. Eight years after diagnosis, he developed a painful, ulcerated glans lesion, surgically excised via glansectomy. Histopathology revealed solid adenocarcinoma with angiolymphatic invasion, high Ki-67 index (20-70%), PSA and CDX2 positivity, and negative CK7/CK20/TTF-1/p63 staining, confirming prostatic origin. Despite the presence of metastasis, disease progression remained indolent, supporting the feasibility of individualized, conservative therapy in selected elderly patients. Literature review highlights venous or lymphatic spread as probable pathways, with prognosis varying widely. This case underscores the importance of considering secondary malignancy in penile lesions, utilizing histopathology and immunohistochemistry for definitive diagnosis, and tailoring management to patient comorbidities and preferences to preserve quality of life.

Mondor's disease of the penis is a rare, benign thrombophlebitis of the superficial dorsal vein, often presenting as a painful, cord-like induration along the penile shaft. Though alarming to patients, it is a self-limiting condition that responds well to conservative management. A 54-year-old male presented with pain and swelling over the dorsal shaft of the penis for 15 days. Examination revealed a tender, cord-like induration without ulceration or discharge. Laboratory parameters were normal. Doppler ultrasonography demonstrated a dilated, thrombosed superficial dorsal vein with loss of venous flow, confirming the diagnosis of penile Mondor's disease. The patient was treated conservatively with nonsteroidal anti-inflammatory drugs, fractionated flavonoids, warm compresses, vitamin supplements, and temporary sexual abstinence. Marked symptomatic relief was observed within 2 weeks, with complete resolution of induration by 6 weeks. Penile Mondor's disease is an uncommon but self-limiting condition that can be effectively managed with conservative therapy. Early recognition, reassurance, and avoidance of unnecessary interventions are essential. Fractionated flavonoids may provide additional benefit in symptom resolution and recovery.

Granulomatosis with polyangiitis (GPA) is a rare systemic vasculitis presenting with penile involvement in approximately 1% of male patients diagnosed with the disease, making genital manifestations exceedingly rare in this context. We aimed to describe here the case of a 34-year-old male patient with a history of GPA presenting to our attention for a genital ulcer that required a coordinated multidisciplinary management. A 34-year-old man with a known history of systemic GPA presented to the Accident and Emergency (A&E) Department with a dorsal penile shaft abscess that progressed into a necrotic ulcer consistent with a localization of GPA (active vasculitis) based on histopathological examination. The patient underwent escharotomy and split-thickness skin grafting (STSG), which failed to take possibly due to local infection with methicillin-resistant Staphylococcus aureus (MRSA) and/or suspected persistent vasculitic activity. Targeted antimicrobial therapy, corticosteroid-based immunosuppression, and hyperbaric oxygen therapy (HBOT) were subsequently implemented, eventually obtaining secondary-intention wound healing. The total hospital stay was 21 weeks. The patient reported a penile curvature of approximately 110° during erection, resulting in the inability to engage in penetrative intercourse. The Visual Analogue Scale (VAS) for the aesthetic and functional outcomes was reported as unsatisfactory (i.e., 2 out of 5). Penile involvement in GPA necessitates a coordinated multidisciplinary approach. Surgical management of GPA-associated large penile skin defects using STSG should be attempted to minimize the hospital stay and to optimize the aesthetic and functional outcomes; however, patients should be informed about a higher likelihood of complications in this setting. The second-intention healing process for large genital skin defects due to GPA may require long hospital stays and may be associated with severe functional issues despite optimal medical management. HBOT may be beneficial in select cases of GPA with genital involvement. Further studies are needed to develop evidence-based guidelines for the management of GPA genital lesions.

Kaposi sarcoma is a vascular neoplasm driven by human herpesvirus 8 (HHV-8), commonly seen in the setting of immunosuppression, such as HIV/AIDS or posttransplant therapy. The presentation of Kaposi sarcoma in HIV-negative patients with multicentric Castleman disease is exceedingly rare, particularly with uncommon histology subtypes and involvement of the penile shaft. A 58-year-old HIV-negative man with a history of HHV-8-associated multicentric Castleman disease presented with a violaceous lesion on the buttock, followed by a crusted ulcer on the penile shaft. Histopathologic evaluation of the penile biopsy revealed an atypical vascular proliferation lacking spindle cell morphology in classic Kaposi sarcoma. Immunohistochemistry showed positivity for HHV-8, podoplanin (PDPN, clone D2-40), CD34, ERG in the proliferating endothelial cells. The morphologic features and the immunoprofile were consistent with the angiomatous subtype of Kaposi sarcoma. Despite aggressive treatment, the patient progressed to multiorgan failure and died shortly after. This report contributes to the limited body of literature on HHV-8-associated Kapsoi sarcoma in the setting of multicentric Castleman disease in HIV-negative patients. It emphasizes the importance of recognizing angiomatous subtype of Kaposi sarcoma with involvement of unusual anatomical sites.

Local anesthetics are fundamental to dermatologic practice, yet their safety profile requires nuanced understanding in high-risk contexts including end-arterial sites, barrier-compromised skin, and scenarios predisposing to systemic toxicity. This narrative review synthesizes contemporary evidence across these three interacting domains to provide an integrated, risk-stratified framework for clinical decision-making. Regarding end-arterial territories, over two decades of clinical evidence encompassing more than 200,000 digital and acral injections has effectively dismantled the historical dogma against epinephrine use in digits, nose, ear, and penis, demonstrating an excellent safety profile when dilute concentrations are used in patients with adequate perfusion, with phentolamine providing reliable rescue for rare, prolonged vasoconstriction. In barrier-compromised skin (e.g. burns, ulcers, and inflammatory dermatoses) topical anesthetics function as absorption amplifiers, with dramatically accelerated systemic uptake that can precipitate local anesthetic systemic toxicity or prilocaine- and benzocaine-induced methemoglobinemia, particularly in infants and frail elderly patients. For large, denuded areas, dilute tumescent infiltration offers a pharmacokinetically safer alternative to high-dose topical therapy. The review details systemic toxicity risk factors, recognition, and management, emphasizing that intravenous lipid emulsion therapy has transformed severe toxicity from an often-fatal event to a manageable emergency. Special considerations for pediatric and geriatric populations, drug interactions, and cumulative dosing across modalities are addressed. The overarching conclusion is that context-sensitive risk stratification which includes integrating vascular status, barrier integrity, and host pharmacokinetics combined with office preparedness including phentolamine and lipid emulsion, enables safe local anesthesia even in traditionally high-risk dermatologic scenarios.

The incidence of ulcerative balanoposthitis (UB) in rams contributes to significant economic losses in the national sheep population. Understanding the immune response in the reproductive tract can aid in developing preventive measures. This study aimed to characterise the immunoglobulin profiles and microbial diversity in the reproductive tract of rams affected by UB, providing insight into the immune responses to this disease. Serum and glans tissue samples from healthy and UB-affected rams were analysed using an ELISA approach to quantify IgG, IgA, and IgM levels. The microbial diversity in nasal, penile swabs, and smegma samples was assessed using an ARISA approach. Significant differences (p ≤ 0.001) were observed between the systemic and localised immune responses. UB-affected rams exhibited higher IgG and IgM levels but lower IgA levels in both serum and glans tissue compared to healthy rams. The study confirmed UB-induced shifts in the microbiome, with significant differences in microbial diversity indices in nasal, penile, and smegma samples. Specifically, there were changes in the nasal fungi Shannon (p = 0.047) and Simpson (p = 0.038) indices, the penile Shannon (p = 0.015) and Simpson (p = 0.006) bacterial indices, and the smegma bacterial species number index (p = 0.042). Correlations between microbial populations and immunoglobulin profiles indicated an interactive immune response in different health statuses. This study highlights the need to understand the immune system of the lower reproductive tract and its interaction with commensal organisms to develop therapeutic immunomodulators for preventing UB in sheep.

Junctional epidermolysis bullosa is a rare autosomal recessive genetic dermatosis which is characterised by cutaneous and mucosal blistering. Cutaneous squamous cell carcinomas arising in areas of chronic wounds and scarring are a well-recognised complication. Mucosal involvement of the respiratory, urogenital and gastrointestinal tract can occur, though reports of associated mucosal carcinomas are scarce. We present a case of an 81-year-old male with junctional epidermolysis bullosa, multiple metastatic cutaneous squamous cell carcinomas and a papillary urothelial carcinoma. He was diagnosed with an invasive, high-grade pT2 papillary urothelial carcinoma of the penile urethra at age 74. This was initially identified by the patient as a nonhealing ulcer adjacent to the penile meatus on a background of recurrent blistering of the glans penis. Staging imaging revealed no nodal enlargement or distant metastasis. Management included a partial urethrotomy of the penile urethra, and he is currently in remission. We hypothesise that the urothelial carcinoma may have developed secondary to a permissive tumour microenvironment, which results from chronic inflammation and fibrosis in junctional epidermolysis bullosa.

We present a case of penile ulcerations in a 42-year-old man with acute promyelocytic leukemia (APML) and leukemia cutis. After treatment with all-trans retinoic acid and arsenic trioxide, he developed localized penile ulcers resistant to antibiotics. Skin biopsy revealed infiltration of atypical cells positive for CD34, MPO, and CD10, confirming leukemia cutis. The ulcers improved following chemotherapy with daunorubicin and azacitidine. This case highlights penile ulcerations as a rare manifestation of leukemia cutis in APML, underscoring the importance of considering leukemic infiltration in differential diagnosis of genital ulcers when infectious causes are excluded.

Penile ulcers are diagnostically challenging dermatologic manifestations with diverse etiologies that make medical management complex. We report a unique presentation of penile ulcers in a man with newly diagnosed antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Penile ulcers are rarely reported in ANCA-associated vasculitides. We aim to provide information about this patient's clinical presentation, diagnostic workup, treatment, and outcome.

Penile calciphylaxis is a rare but life-threatening manifestation of calcific uraemic arteriolopathy, most often seen in patients with end-stage renal disease (ESRD) on dialysis. Its diagnosis is frequently delayed, and its presence carries a poor overall prognosis. Given its rarity, treatment strategies and their efficacy have been understudied and may include observation, medical therapy, radical surgery or hyperbaric oxygen therapy. In this case, we describe a patient with ESRD presenting with a rapidly progressive penile lesion ultimately diagnosed as penile calciphylaxis. Our patient was ineligible for hyperbaric oxygen therapy and declined surgical management. Consequently, unlike many reported cases requiring surgical management nonetheless resulting in poor outcomes, our patient experienced lesional resolution with conservative therapy, specifically intravenous sodium thiosulfate and structured wound care with medical-grade honey, within 9 months after presentation. This case highlights a novel non-surgical approach to a difficult clinical situation and shows the potential efficacy and novelty of non-surgical management in select patients where penile calciphylaxis is diagnosed early in its course.