Multifocal penile intraepithelial neoplasia - targeted treatment with imiquimod

A 78-year-old male sought dermatologic consultation for multifocal persistent red lesions of the glans penis. Various topical treatments had proved unsuccessful. Histologic examination revealed penile intraepithelial neoplasia (PIN). Polymerase chain reaction (PCR) showed amplification of human papillomavirus type 16 (HPV-16) DNA. Urological consultants recommended amputation of the glans; the patient rejected this, as well as any other surgical procedure. Therefore, he was treated in our dermatologic practice with imiquimod 5 % cream administered daily over 12 weeks. After therapy was completed, no clinical or histologic evidence of residual tumor was found and HPV-16 DNA was no longer detectable. Local skin reactions such as erosions and edema of the glans accompanied by tingling and itching were well-tolerated by the patient. Imiquimod 5 % cream may represent an alternative local treatment option for multifocal PIN.