It is important to distinguish this benign condition from the clinically similar neoplastic erythroplasia of Queyrat. Analogous lesions sharing both clinical and histologic features of PCB have been reported in women as vulvitis circumscripta plasmacellularis. The patient, a male of middle age or older, usually presents with a characteristic lesion of the glans penis or prepuce, present for an average of 1-2 years before diagnosis. Symptoms are minimal, but patients may complain of mild pruritus or tenderness.
Some patients present for evaluation because of cosmetic concerns or anxiety.
Erosive and vegetative variants have been reported. Importantly, all confirmed cases have been in uncircumcised males. It has been proposed that friction, trauma, heat, poor hygiene, chronic infection with Mycobacterium smegmatis, a reactive response to an unknown exogenous or infectious agent, an immediate hypersensitivity response mediated by immunoglobulin E class antibodies, and hypospadias may be predisposing or inciting agents. Diagnosis of PCB is confirmed by distinctive histologic findings upon skin biopsy. Skin biopsy of the PCB lesion reveals suggestive, if not distinctive, changes in the epidermis and dermis.