Dermatology: Practical and Conceptual


Dermatology Practical & Conceptual

Image Letter | Dermatol Pract Concept. 2021;11(4):e2021121 1

Penile Angiokeratomas (PEAKERs): An exceedingly 
Rare Clinical Variant 

Jaime Piquero-Casals1, Daniel Morgado-Carrasco2, Juan Francisco Mir-Bonafé3,  
Eduardo Rozas-Muñoz4

1 Department of Dermatology, Dermik Multidisciplinary Dermatological Clinic, Barcelona, Spain

2 Department of Dermatology, Barcelona Hospital Clínic, Barcelona University, Spain

3 Department of Dermatology, Son Llàtzer Hospital, Palma de Mallorca, España

4 Department of Dermatology, San Pablo Hospital de, Coquimbo, Chile.

Citation: Piquero-Casals J, Morgado-Carrasco D, Mir-Bonafé JF, Rozas-Muñoz E. Penile angiokeratomas (PEAKERs): an exceedingly rare 
clinical variant. Dermatol Pract Concept. 2021;11(4):e2021121. DOI: https://doi.org/10.5826/dpc.1104a121

Accepted: March 14, 2021; Published: October 2021

Copyright: ©2021 Piquero-Casals et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 
License BY-NC-4.0, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original 
authors and source are credited.

Funding: None.

Competing interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding author: Jaime Piquero-Casals, MD PhD, Department of Dermatology Dermik Multidisciplinary Dermatological Clinic. 
Barcelona, Spain. Email: j.piquero@dermik.es

Case Presentation

An otherwise healthy 29-year-old man presented with mul-

tiple 1 to 3 mm purple papules present in the last 5 years 

on his glans and scrotum (Figure 1A). He had no history of 

sexually transmitted diseases, nor he experienced trauma to 

the area. Dermoscopy revealed dark blue and red lacunae, 

together with erythema. Dermoscopic analysis confirmed 

angiokeratoma diagnosis (Figure 1B). After explaining the 

benign nature of the lesions, the patient refused to receive 

any treatment and the papules remained stable in number at 

a 6-month follow-up visit.

Teaching Point

Genital angiokeratomas are benign vascular lesions occurring 

most commonly on the scrotum or vulva. 

The differential diagnosis of angiokeratomas includes 

common nevus, blue nevus, primary melanoma, or cutaneous 

metastasis, angiomas, as well as others lesions with vascular 

patterns, such as basal cell carcinomas, and pyogenic granu-

lomas. When angiokeratomas are diffusely present, evaluation 

for a lysosomal storage disease (LSDs) (for instance, Fabry 

disease) and possible referral to a clinical geneticist should 

be considered [1].

Penile angiokeratomas (PEAKERs) are an uncommon 

subtype of genital angiokeratomas [2]. These benign vas-

cular tumors typically presenting as multiple lesions on the 

corona glans penis. Treatment includes cryotherapy and 

lasers, among others. Dermoscopy should be included as a 

part of the clinical inspection to avoid unnecessary invasive 

investigation [2].

Informed Consent: The patient gave written consent for 

publication of photographs related to the case.



2 Image Letter | Dermatol Pract Concept. 2021;11(4):e2021121

References

1. Chan B, Adam DN. A review of Fabry disease. Skin Therapy Lett. 

2018;23(2):4–6. PMID: 29562089

2. Cohen PR, Celano NJ. Penile Angiokeratomas (PEAKERs) 

 Revisited: A Comprehensive Review. Dermatol Ther (Heidelb). 

2020;10(4):551-567. DOI: 10.1007/s13555-020-00399-3.  

PMID: 32506249.

Figure 1. (A) Multiple 1-3 mm purple papule on glans and scrotum of 5 years’ duration. (B) Dermoscopy of angiokeratoma revealing multi-

ple dark blue and red lacunae, together with erythema.