Male external genital skin disorders: a retrospective analysis from a tertiary hospital in China

Male genital dermatoses encompass a diverse range of infectious, inflammatory, and neoplastic conditions with overlapping clinical presentations, often leading to diagnostic challenges. Misdiagnosis can result in inappropriate management and significant patient distress, particularly given the sensitive nature of the anatomical site. Although histopathology remains the diagnostic gold standard, non-invasive tools such as dermoscopy are becoming increasingly valuable for preliminary evaluation. A thorough understanding of the clinical features associated with male genital dermatoses is essential for achieving accurate diagnoses.

Our retrospective study analyzed 572 histopathologically confirmed cases of lesions on the male external genitalia at Peking Union Medical College Hospital from 2015 to 2025. Data included demographics, disease duration, lesion distribution, dermoscopy results if exists, and clinical-dermatoscopic-pathological concordance.

The cohort with a mean age of 47.6 years, exhibited distinct age-specific patterns: adolescents (1.2%) had inflammatory/autoimmune conditions; adults (70.6%) showed human papillomavirus-associated (Bowenoid papulosis, genital warts) and inflammatory diseases (lichen sclerosus); and elderly patients (28.1%) had higher malignancy rates (extramammary Paget's disease, squamous cell carcinoma). Overall, inflammatory diseases (33.7%) and tumors (33.4%) were the most common diagnoses. Notably, diagnostic clinical-pathological discordance was observed in 34.6% of cases, particularly for lichen planus (4.9%) and extramammary Paget's disease (2.8%).

This study highlights the diverse etiologies of male genital dermatoses and underscores the necessity of age-stratified evaluations. The use of dermoscopy improves diagnostic accuracy and minimizes the need for unnecessary biopsies. Conditions such as extramammary Paget's disease, bowenoid papulosis, and lichen sclerosus require heightened awareness due to their potential for malignancy or diagnostic complexity. Integrating clinical, dermoscopic, and histopathological data is critical for effective management.