Unusual Growths on the Penis: A Dermatological Perspective

I would like to inquire about issues related to growths on the penis?

Hello doctor, I developed a somewhat white, raised, round bump on the right side of the coronal sulcus of my penis around the end of last year.
It is somewhat hard, and pressing it causes a slight pain.
Since I have not engaged in any sexual activity, I thought it would be best to consult a urologist at a local clinic.
The doctor performed a brief physical examination and immediately suggested it might be genital warts.
I was prescribed Urekin cream, which I applied for about two weeks.
Unexpectedly, while treating the right side, a similar bump appeared on the left side of the coronal sulcus.
I looked up images of genital warts online, and they did not resemble my condition very closely.
Could this be a result of the cream forcing something out, or was it just a coincidence that it appeared at this time?
I applied the cream to both sides, and eventually, they became softer.
The upper part of the bumps even fell off easily.
I later purchased Phenol and applied it, which caused the skin in those areas to gradually peel off, similar to dead skin.
The appearance has improved significantly, turning into a hard, thickened skin, resembling a callus.
While applying the medication, I decided to get an HPV DNA test at a medical laboratory, as I heard it is one of the mainstream and accurate testing methods.
However, I have visited three different labs for this test, and all results came back negative.
Although the lesions do not look as they did initially, there are still remnants of them.
Despite three negative tests directly on the lesions, I am starting to doubt whether this is indeed genital warts.

The two areas have not shown significant changes; they have become two thickened, hardened spots that are still somewhat whiter than the surrounding skin.
I learned that dermatologists also examine such conditions, so I visited a dermatologist.
However, since the appearance has changed, the dermatologist could not confirm the diagnosis immediately.
The dermatologist mentioned that they only see glands now and treated me with liquid nitrogen twice.
After the second treatment, the hardened areas came off like dead skin, revealing red skin underneath.
I then applied a medication for frostbite that the doctor prescribed, and the skin has since softened even more.
However, when I press on it, I can still feel a slight thickness compared to the surrounding skin, and the recovering skin remains somewhat whiter than the surrounding area.
I have shared the entire process, and it has been nearly eight months since my first visit to the doctor.
I want to clarify that I have tested negative for HPV three times in the lesion areas, and there has been no significant change in the lesions.
I have researched online and found that my condition has neither increased nor resembles the images I found.
The lesions have turned into thickened calluses that can shed their dead skin and shrink.
Now, after the cryotherapy, I can easily remove the thickened skin.
What exactly is this? I am considering getting one last HPV DNA test.
Since the first doctor simply diagnosed it as genital warts, I have become somewhat obsessive about cleanliness, washing my hands to the point of dryness, and I am worried about the possibility of transmission to others, which has made me somewhat depressed.
I am contemplating remaining single to avoid harming others, but I am still uncertain about what this condition is.
Since the lab tests have shown no issues, I just want the most accurate diagnosis, which I believe would be a skin biopsy.
However, I would like to know if a biopsy can still be performed on these two areas in their current state.
Is it accurate, or does there need to be an active lesion for a biopsy to be reliable?

Zoo, 20~29 year old female. Ask Date: 2022/08/04

Dr. Wu Yuxin reply Dermatology

Urologists can assist with biopsy examinations, and pathological testing is the most accurate.

Reply Date: 2022/08/04

More Info

Understanding unusual growths on the penis can be a complex issue, especially when it involves symptoms that are concerning and persistent. Based on your description, it seems you have experienced a growth on the right side of the coronal sulcus of the penis, which has evolved over time and has been treated with various topical medications. The fact that you have had multiple negative HPV DNA tests is a significant point to consider in your evaluation.

Firstly, it is essential to understand that the penis can develop various types of growths, including benign conditions such as pearly penile papules, sebaceous cysts, or even warts (condyloma acuminata) caused by HPV. The appearance of a white, slightly raised, and somewhat hard bump could suggest a few possibilities, including a benign cyst or a wart. The pain and discomfort you describe when applying pressure could indicate inflammation or irritation of the growth.

The treatment you received with topical medications, including the urea cream and liquid nitrogen cryotherapy, suggests that your healthcare providers were considering the possibility of a wart or similar lesion. Cryotherapy is often used to treat warts by freezing the tissue, which can lead to the destruction of the abnormal cells. The fact that the lesions have softened and become less prominent after treatment is a positive sign, indicating that the treatment may have been effective.

Your concern about whether the topical treatment could have caused the appearance of new lesions is understandable. It is possible that the initial treatment may have stimulated the surrounding skin, leading to the emergence of new growths, or it could simply be a coincidence in timing. The HPV virus can remain dormant in the body, and new lesions can appear at any time, especially if the immune system is compromised or under stress.

Regarding your question about the accuracy of HPV testing and the potential for a skin biopsy, it is important to note that HPV DNA tests are highly specific for detecting the presence of the virus but may not always correlate with visible lesions. If the lesions have changed significantly or resolved, a biopsy may still be informative, but it is generally more effective when there are active lesions present. A biopsy can provide a definitive diagnosis by examining the tissue under a microscope, which can help rule out or confirm conditions such as HPV-related lesions or other dermatological issues.

In terms of your emotional well-being, it is crucial to address the anxiety and stress that can accompany concerns about sexually transmitted infections (STIs) and unusual growths. It may be beneficial to speak with a mental health professional who can help you manage these feelings and provide support as you navigate this situation.

In conclusion, while your negative HPV tests are reassuring, it is essential to continue monitoring the area and maintain open communication with your healthcare providers. If new lesions appear or if you have ongoing concerns, seeking a consultation with a dermatologist who specializes in genital dermatology may provide further clarity and peace of mind. Remember, maintaining good hygiene and being proactive about your health is key, but it is also important to manage anxiety and seek support when needed.

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