This is the Story of my sade sex-less life!!! Differential Diagnosis of Noninfectious Penile Lesions Lesion Characteristic symptoms Typical clinical appearance Differential diagnosis Papulosquamous Psoriasis Pruritus Red or salmon-colored, papulosquamous, circinate plaques often associated with white or silvery scales; similar extragenital lesions Carcinoma in situ Pearly papules Asymptomatic Small dome-shaped, skin-colored papules in a ring-like distribution at the coronal sulcus of the glans penis Lichen nitidus, angiokeratomas Inflammatory Lichen sclerosus balanitis xerotica obliterans Phimosis, painful erections, obstructed voiding, pruritus, pain, bleeding Hypopigmented, thinned, phimotic prepuce; cellophane texture; annular or figurate configurations; isolated to the prepuce and glans penis Carcinoma in situ, leukoplakia, scleroderma Lichen nitidus Asymptomatic Pinhead-sized, hypopigmented papules, often extragenital Herpes simplex virus infection, pearly papules Lichen planus Pruritus, soreness Flat-topped, polygonal, violaceous plaques; often extragenital Secondary syphilis Vascular Angiokeratomas Asymptomatic Red or blue papules, often with annular or figurate configurations; may appear only on the glans penis or also on the scrotum, groin, thighs, or abdominal wall Pearly papules Neoplastic Carcinoma in situ erythroplasia of Queyrat, Bowen disease Pruritus, pain Variable appearance; plaque or ulcer isolated to the glans penis, prepuce, and other areas of the penis; biopsy needed for diagnosis Psoriasis, lichen sclerosus, Zoon balanitis, invasive penile cancer, herpes simplex virus infection, syphilis, group B streptococcal balanitis, candidiasis, Reiter syndrome Invasive squamous cell carcinoma Delayed presentation, usually painless Exophytic or endophytic appearance; presentation varies; local or metastatic; biopsy needed for diagnosis Giant condyloma human papillomavirus infection TABLE 2.