Purplish Papules on the Penis: A Case of Penile Angiokeratomas (PEAKERs)

A 26-year-old man presented with asymptomatic, purplish, raised lesions on the penis, first noted 6 months prior and increasing in size over the last month. Examination revealed multiple purplish papules coalescing into a plaque on the glans penis, with a few filiform papules on the corona [Figure 1a]. Dermoscopy showed red and blue lacunae with a whitish veil and mild perilesional erythema [Figure 1b]. Clinical diagnosis of penile angiokeratoma was confirmed by a 4 mm punch biopsy, which revealed hyperkeratosis, acanthosis, and dilated vascular spaces with red blood cells and lymphocytic infiltrates [Figure 1c]. The lesions were treated with radiofrequency ablation.Figure 1: a: Polarized dermoscopy of the lesions shows red and blue lacunae with a whitish veil and mild perilesional erythema (DermLite DL4 dermatoscope, 10x, polarized). b: H and E (40X) shows hyperkeratosis and acanthosis in the epidermis. In the superficial dermis, dilated vascular spaces containing red blood cells are evident, accompanied by lymphocytic infiltrates. c: Multiple skin-colored to purplish papules coalescing to form plaques with a few filiform papules on the glans penis.Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.