title: Differentiation between balanitis and carcinoma in situ using reflectance confocal microscopy.
abstract: OBJECTIVE
  Zoon plasma cell balanitis is a benign inflammatory disease of genital skin. It may be difficult to clinically distinguish between balanitis and carcinoma in situ (CIS); thus, a biopsy may be needed to exclude malignant disease. Reflectance confocal microscopy (RCM) is an in vivo imaging method to get morphologic information about architecture and single cells in the skin.
  
  
  OBJECTIVE
  To evaluate the ability of RCM to differentiate between balanitis and CIS compared with the gold standard histopathologic methods.
  
  
  METHODS
  Observer blinded study.
  
  
  METHODS
  A referral center.
  
  
  METHODS
  Fifteen patients with balanitis or CIS.
  
  
  METHODS
  Patients were assessed by clinical, histologic, and RCM findings. All lesions were imaged with the Vivascope 1500. In 5 cases of balanitis, the surrounding, noninvolved skin also was evaluated.
  
  
  METHODS
  Local recurrence, nodal metastasis, disease-specific death, overall death.
  
  
  RESULTS
  The clinical diagnoses showed 9 cases of balanitis and 6 cases of CIS. With histopathologic analysis, 12 cases of balanitis and cases of CIS were diagnosed, and RCM evaluation confirmed these diagnoses. The most relevant RCM criteria for CIS were atypical honeycomb pattern, disarranged epidermal pattern, and round nucleated cells. Balanitis showed a nucleated honeycomb pattern and vermicular vessels. Scattered small bright cells and round vessels were present in all lesions. The adjacent normal skin showed a typical honeycomb pattern and round papillary vessels.
  
  
  CONCLUSIONS
  We were able to differentiate between balanitis and CIS. Reflectance confocal microscopy may help to avoid biopsies at this sensitive site.
authors: Department of Dermatology, Medical University of Graz, Graz, Austria.
authors: Edith
authors: E
authors: Arzberger
authors: Peter
authors: P
authors: Komericki
authors: Verena
authors: V
authors: Ahlgrimm-Siess
authors: Cesare
authors: C
authors: Massone
authors: Dmitry
authors: D
authors: Chubisov
authors: Rainer
authors: R
authors: Hofmann-Wellenhof
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001446:Balanitis / Q000175:diagnosis*; D002278:Carcinoma in Situ / Q000175:diagnosis*; D003937:Diagnosis, Differential; D052816:Foreskin / Q000473:pathology*; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods*; D008875:Middle Aged; D010412:Penile Neoplasms / Q000175:diagnosis*; D011446:Prospective Studies