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Endgames Case Review

Cobblestone-like rashes on the penis

BMJ 2022; 379 doi: (Published 06 October 2022) Cite this as: BMJ 2022;379:e070996
  1. Li-Wen Zhang, attending dermatologist,
  2. Wen-Ju Wang, attending dermatologist,
  3. Tao Chen, professor of dermatology
  1. 1Department of Dermatovenereology, Chengdu Second People’s Hospital, Chengdu, Sichuan, China
  1. Correspondence to: T Chen 13980427003{at}

A young boy presented to the dermatology clinic with asymptomatic papillomatous brown plaques on his penis that had appeared two weeks previously. He denied itching, pain, or other physical complaints. There was no previous inflammation and trauma at the same site. A fungal direct microscopic examination was negative. Dermoscopy revealed multiple brown polygonal granules with a cobblestone pattern (fig 1a). The plaques were partially removed with a 75% ethyl alcohol swab (fig 1b) but had no response to cleaning with soap and water.

Fig 1

Dermoscopy showing (a) multiple brown polygonal granules with a cobblestone pattern, and (b) the …

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