We present a man in his 70s with a hyperkeratotic whitish plaque over the internal prepuce and glans. The lesion was slowly growing for four years prior to presentation and was resistant to several topical treatments. The histological examination of the lesion revealed marked hyperkeratosis and pseudoepitheliomatous hyperplasia, supporting the diagnosis of pseudoepitheliomatous, keratotic, and micaceous balanitis. It is important to be aware of this uncommon but potentially malignant condition affecting elderly men.
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