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Skin disorders and penile disorders following intravesicular administration in elderly patients: 2 case reports Two men developed skin disorders and penile disorders following intravesicular administration of BCG (patient 1) and mitomycin (patient 2) for superficial bladder cancer. A 69-year-old man (patient 1) received his sixth intravesicular BCG inoculation [dosage not stated] and, 1 month later, presented with discomfort related to oedema involving his penis, an ulcer at the base of his penis, and papules on his glans penis. On examination, he had a punched-out ulcer (1 × 0.6cm) with an adjacent indurated erythematous patch, papules on his penis head, nodules on the shaft of his penis and inguinal lymphadenopathy. A biopsy from the dorsal aspect of his penis, adjacent to his ulcer, revealed ulceration with foci of granulomatous inflammation and dermal necrosis. Because of the granulomatous inflammation secondary to BCG spillage during the inoculation, he was diagnosed with cutaneous tuberculosis, and started receiving oral isoniazid, rifampicin, ethambutol and pyridoxine [vitamin B6]. After 6 weeks, his ulceration and the adenopathy had resolved. A 73-year-old man (patient 2) received his second cycle of mitomycin [dosage not stated] and, during withdrawal of the catheter, mitomycin spilled over his perineal area. About 24–48 hours later, his perineum became inflamed and he developed an erosion at the shaft of his penis. Over the next few days, he developed priapism and discolouration of his penis. He received oral antifungals, oral corticosteroids and antifungals, without any improvement in his condition. He underwent stent placement to manage his concurrent bladder neck contracture, and was referred for a possible penectomy; at the time of referral, he had priapism, oedema and discolouration of his penis. An examination revealed a firm, erect penis with an adherent, dark crust (2.5cm) on the distal right lateral aspect of the shaft of his penis, adjacent to his glans. Background erythema of his penis and scrotum was observed and he had proximal lymphoedema. A culture from the pustules at his penis base grew Staphylococcus aureus and he started receiving cotrimoxazole [trimethoprim/ sulfamethoxazole]. A patch test was consistent with an allergic contact reaction to mitomycin. He received conservative treatment involving wet dressing therapy and a saline solution, to remove the thick crust of his penis. Following limited improvement in his condition, a compression program was initiated, but it was unsuccessful. He subsequently underwent a radical penectomy involving the removal of his entire penis along with the bulb and crura of his penis, and a perineal urethrostomy was created. Author comment: "Patient 1 developed complications of [intravesicular] BCG therapy . . . In the second case presented, spilling of [mitomycin] led to priapism and necrosis of the penis . . . We postulate that a direct toxic insult was caused by the mitomycin spill on the penis". Kureshi F, et al. Cutaneous complications of intra