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Radiation-induced genital porokeratosis and basal cell carcinoma

Porokeratosis (PK) is a disorder of keratinization characterized by irregular annular plaques with central atrophy surrounded by a hyperkeratotic raised border known histologically as the cornoid lamella.1,2 Various forms of the disease include plaque-type PK of Mibelli, disseminated superficial actinic PK, linear PK, PK palmaris et plantaris disseminata, and punctate PK. Risk factors include genetic inheritance, ultraviolet light exposure, and immunosuppression, all having the potential for malignant transformation. Lesions most commonly occur in the extremities or along the lines of Blaschko, with genital localization rarely reported in Asian men.1,3 Treatment modalities include cryotherapy, surgical excision, CO2 laser ablation, topical 5% 5-fluorouracil, vitamin D3 analogs, retinoids, and imiquimod cream.1 Malignant change has been reported in nearly all types of PK.4 The current literature suggests an increased risk for malignant transformation in patients with linear PK, previous exposure to radiation or large lesions on the extremities.5 We report the development of multiple PK and basal cell carcinoma (BCC) throughout the pubic area in a Caucasian male who had been previously exposed to ionizing radiation for prostate cancer.