Dermoscopy of Zoon balanitis

A 50-year-old male presented with an asymptomatic skin lesion over the glans. There is no history of itching, burning, or oozing. These lesions had been present for the past 6 months. Genital examination revealed a single well-circumscribed shiny orange-red moist slightly raised plaque over the glans penis with multiple bright red speckled spots, “cayenne pepper spots” seen in the background were noted [Figure 1a and b]. Dermoscopy showed a reddish-orange structureless area and curved vessels [Figure 2]. Based on the clinical examination and the characteristic dermoscopy findings, Zoon balanitis was diagnosed.

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Figure 1:

(a and b) Single well-circumscribed shiny orangered moist slightly raised plaque over the glans penis with multiple bright red speckled spots, “cayenne pepper spots.”

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Figure 2:

Reddish-orange structureless (black asterix), curved vessels (green arrow), yellow-white areas (black arrows), and serpentine vessels (blue arrows).

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Zoon balanitis/plasma cell balanitis of Zoon is an idiopathic chronic benign inflammatory mucositis of genitalia. It presents as a single well-defined, orange-red, shiny, moist macule to slightly raised plaque, with multiple pinpoint bleeding spots resembling cayenne pepper spots.^[1] Dermoscopy of the lesion demonstrates the presence of focal reddish-orange structureless areas [Figure 2] corresponding to the combination of underlying vascular dilation, red cell extravasation, and hemosiderin deposition in the dermis in histology. The curved vessels, serpentine in orientation [Figure 2], correspond to the vascular proliferation and overlying epidermal atrophy. Yellow-white areas represent areas of dermal fibrosis, indicating a chronic nature of the lesion.^[2] Given the presence of distinct dermoscopic features, it can add as a rapid tool in the diagnosis of Zoon balanitis. The sterility was maintained by placing an ice cap on the contact surface of the dermoscope. It can be particularly beneficial in averting the need for invasive procedures like biopsy, as such procedures can add to the anxiety of the patient, especially given the sensitive area involved.