A penile lesion is any abnormality on the skin of the penis, such as a sore, bump, ulcer, or discolored patch. These lesions have many causes, from minor skin irritation to more complex medical conditions. Because the appearance of a lesion does not reliably indicate its source, self-diagnosis is misleading. A professional medical evaluation is the only way to get an accurate diagnosis and proper care, as attempting to self-treat can delay effective treatment or worsen the condition.
Potential Causes of Penile Lesions
Infectious Causes
Many penile lesions are caused by infections. Sexually transmitted infections (STIs) are a common source. Genital herpes, from the herpes simplex virus (HSV), presents as small blisters that form painful sores. Syphilis can cause a firm, round, and painless sore called a chancre, while human papillomavirus (HPV) can lead to genital warts, which may be raised, flat, or cauliflower-shaped.
Other infections can also affect the penile skin. Fungal infections, or jock itch, can cause red, scaly, and itchy rashes on the penis and surrounding skin. Bacterial infections might also develop, particularly in uncircumcised individuals where moisture can accumulate, leading to inflammation and discomfort.
Inflammatory Skin Conditions
Dermatological conditions that affect skin elsewhere can also appear on the penis. Psoriasis, an autoimmune condition, may cause red or salmon-colored plaques with a silvery scale. Contact dermatitis results from an allergic reaction or irritation from substances like latex, soaps, or chemicals, causing an itchy, red rash.
Lichen sclerosus is an inflammatory condition that presents as white, shiny patches of skin that can become thin and crinkled, potentially leading to a tightening of the foreskin (phimosis). Another inflammatory issue is lichen planus, which can cause itchy, flat-topped, purplish bumps. These conditions are not contagious but require medical management.
Benign (Non-Cancerous) Growths
Many bumps and spots on the penis are harmless. Pearly penile papules are small, flesh-colored bumps that form in rows around the head of the penis and are a normal anatomical variation. Fordyce spots are another common finding, appearing as small, yellowish or white spots on the shaft or glans, which are visible sebaceous glands.
Other benign growths include cysts, which are small, sac-like pockets of tissue that feel like lumps under the skin. Skin tags, which are soft, flesh-colored growths, can also occur in the genital area.
Precancerous and Cancerous Conditions
Some penile lesions can be a sign of a precancerous or cancerous condition. Bowen’s disease, or penile intraepithelial neoplasia (PIN), is an early form of skin cancer that appears as a persistent, scaly, reddish-brown patch. It can progress to invasive squamous cell carcinoma, the most common type of penile cancer.
Signs of squamous cell carcinoma can include a lump, a non-healing ulcer, a reddish and velvety rash (erythroplasia of Queyrat), or a wart-like growth. Other symptoms might include changes in skin color, thickening of the skin, or a persistent discharge with an odor. These conditions require immediate medical evaluation.
The Diagnostic Process
Medical History and Physical Exam
The first step in diagnosis is a consultation with a healthcare provider. The physician will ask about the lesion’s history, including when it appeared, if it has changed, and if it is associated with symptoms like pain or itching. You will also be asked about your sexual history, hygiene practices, and any personal or family history of skin conditions or cancer.
Following this, the provider will perform a physical examination, visually inspecting the lesion and the surrounding genital region. The doctor will note the lesion’s size, shape, color, and texture. The inguinal lymph nodes in the groin will also be checked for swelling, which can indicate an infection or other issue.
Diagnostic Tests
Depending on the exam findings, further tests may be necessary. If an infection is suspected, the provider may use a swab to collect a fluid or cell sample from the lesion. This sample is sent to a laboratory for analysis to identify the specific microorganism.
Blood tests are also a common diagnostic tool for detecting systemic infections. A blood sample can be used to screen for antibodies to STIs like syphilis or HSV. These tests can help confirm a diagnosis even if the primary lesion has started to heal.
Biopsy
If a lesion’s nature is unclear or cancer is suspected, a biopsy is often recommended. In this procedure, a small tissue sample is removed from the lesion after the area is numbed with a local anesthetic.
The tissue sample is sent to a pathologist for microscopic analysis. This examination can provide a definitive diagnosis by identifying the specific cellular characteristics of the condition. A biopsy is the standard for diagnosing skin cancers and many inflammatory skin disorders.
General Treatment Options
Medications
For infections, medications are a primary therapy. Fungal infections are treated with topical antifungal creams, while bacterial infections require oral or topical antibiotics.
For viral infections like genital herpes, there is no cure, but antiviral medications can manage the condition by shortening the severity of outbreaks and reducing recurrences. For inflammatory conditions like psoriasis or lichen sclerosus, topical corticosteroids are often prescribed to reduce inflammation and itching.
Procedures
A medical procedure may be needed to remove or treat a lesion. Cryotherapy, which freezes the lesion with liquid nitrogen, is a common treatment for genital warts. Surgical excision, where the lesion is cut out, may be used for cysts, certain benign growths, or suspicious lesions.
Topical chemotherapy creams can be applied directly to the skin to destroy abnormal cells in some precancerous conditions. Laser ablation, which uses a focused beam of light to vaporize tissue, is another option for certain warts and precancerous spots.
Management
Chronic conditions like genital herpes and psoriasis require ongoing strategies to control flare-ups and maintain skin health. This involves suppressive therapy with daily antiviral medication for herpes or consistent use of topical treatments for psoriasis. Regular follow-up appointments allow a doctor to monitor the condition, adjust treatment, and check for any changes.
When to Consult a Healthcare Provider
A prompt medical visit is needed for a sore that does not heal within a few weeks or for any rapid changes in a mole’s size, shape, or color. Other warning signs include bleeding, persistent itching, or pain from the lesion. The presence of pus, a foul odor, or accompanying symptoms like fever, fatigue, or swollen lymph nodes also require medical attention.