What is the treatment for a newly developed penile skin tag resembling a polyp in an adult male?

Treatment of Newly Developed Penile Skin Tag/Polyp

Primary Recommendation

Simple excision is the definitive treatment for a newly developed penile skin tag or polyp-like lesion, but biopsy must always be performed to exclude malignancy, particularly if there are any atypical features such as irregular borders, color changes, or rapid growth. 1

Critical First Step: Rule Out Malignancy

Before treating any new penile lesion as a benign skin tag, you must exclude serious pathology:

• Biopsy is mandatory if: 1

  • The lesion shows hyperkeratosis, erosion, or erythema
  • There are new warty or papular features
  • The lesion fails to respond to conservative management
  • There is any diagnostic uncertainty

• Document specific characteristics: 1

  • Exact diameter and location on the penis
  • Morphology: papillary, nodular, ulcerous, or flat
  • Color and border characteristics
  • Number of lesions present

Treatment Algorithm

For Confirmed Benign Fibroepithelial Polyp/Skin Tag:

1. Surgical excision is the standard approach 2, 3

   • Simple excision with histological confirmation
   • Send all excised tissue for pathology to exclude penile intraepithelial neoplasia (PeIN) 1

2. Alternative for very small lesions: 4

   • Cryotherapy may be considered for tiny lesions
   • Laser therapy is an option for cosmetic concerns

If Diagnostic Uncertainty Exists:

• Do NOT treat empirically - obtain tissue diagnosis first 1
• Consider differential diagnoses that require different management:
  • Bowenoid papulosis (requires biopsy, has malignant potential) 1, 5
  • Erythroplasia of Queyrat (penile intraepithelial neoplasia) 1, 6
  • Condyloma acuminata (HPV-related, requires different treatment) 5

Critical Pitfalls to Avoid

• Never assume a penile lesion is benign without histological confirmation if there are any atypical features 1
• Do not confuse with pearly penile papules, which are normal anatomical variants requiring only reassurance and no treatment 5, 4
• Fibroepithelial polyps can rarely undergo malignant transformation, making histological examination essential 2
• Large or rapidly growing polyps warrant more urgent evaluation to exclude underlying pathology 2, 3

Special Considerations

• If associated with lichen sclerosus: The lesion may represent postinflammatory changes requiring different management with topical clobetasol propionate 0.05% 1, 7
• If the patient has risk factors for penile cancer (uncircumcised, HPV exposure, lichen sclerosus history), maintain higher suspicion and lower threshold for biopsy 1, 6
• Giant fibroepithelial polyps (>1-2 cm) may be associated with obesity, insulin resistance, or chronic inflammation and require complete excision 3

Post-Excision Management

• All excised tissue must undergo histopathological examination to confirm diagnosis and exclude dysplasia or malignancy 1, 2
• If histology reveals PeIN or dysplasia: Refer to urology/oncology for intensive surveillance every 3-6 months 6
• If benign fibroepithelial polyp confirmed: Reassure patient, no further follow-up needed unless recurrence 2, 3