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Edmonds EVJ, Hunt S, Hawkins D, Dinneen M, Francis N, Bunker CB. Clinical parameters in male genital lichen sclerosus: a case series of 329 patients. J Eur Acad Dermatol Venereol 2011; 26:730-7. [PMID: 21707769 DOI: 10.1111/j.1468-3083.2011.04155.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The dermatological aspects of male genital lichen sclerosus (MGLSc) have not received much prominence in the literature. Sexual morbidity appears under-appreciated, the role of histology is unclear, the relative places of topical medical treatment and circumcision are not established, the prognosis for sexual function, urinary function and penis cancer is uncertain and the pathogenesis has not been specifically studied although autoimmunity (as in women) and HPV infection have been mooted. OBJECTIVE To illuminate the above by analysing the clinical parameters of a large series of patients with MGLSc. METHODS A total of 329 patients with a clinical diagnosis of MGLSc were identified retrospectively from a dermatology-centred multidisciplinary setting. Their clinical and histopathological features and outcomes have been abstracted from the records and analysed by simple descriptive statistics. RESULTS The collation and analysis of clinical data derived from the largest series of men with MGLSc ever studied from a dermatological perspective has been achieved. These data allow the conclusions below to be drawn. CONCLUSIONS MGLSc is unequivocally a disease of the uncircumcised male; the adult peak is late in the fourth decade; dyspareunia is a common presenting complaint; non-specific histology requires careful interpretation; most men are either cured by topical treatment with ultrapotent steroid (50-60%) or by circumcision (>75%); effective and definitive management appears to abrogate the risk of developing penile squamous cell carcinoma; urinary contact is implicated in the pathogenesis of MGLSc; HPV infection and autoimmunity seem unimportant.
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Affiliation(s)
- E V J Edmonds
- Departments of Dermatology, Chelsea & Westminster Hospital, London, UK
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Morris BJ, Gray RH, Castellsague X, Bosch FX, Halperin DT, Waskett JH, Hankins CA. The Strong Protective Effect of Circumcision against Cancer of the Penis. Adv Urol 2011; 2011:812368. [PMID: 21687572 PMCID: PMC3113366 DOI: 10.1155/2011/812368] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 03/09/2011] [Indexed: 01/30/2023] Open
Abstract
Male circumcision protects against cancer of the penis, the invasive form of which is a devastating disease confined almost exclusively to uncircumcised men. Major etiological factors are phimosis, balanitis, and high-risk types of human papillomavirus (HPV), which are more prevalent in the glans penis and coronal sulcus covered by the foreskin, as well as on the penile shaft, of uncircumcised men. Circumcised men clear HPV infections more quickly. Phimosis (a constricted foreskin opening impeding the passage of urine) is confined to uncircumcised men, in whom balanitis (affecting 10%) is more common than in circumcised men. Each is strongly associated with risk of penile cancer. These findings have led to calls for promotion of male circumcision, especially in infancy, to help reduce the global burden of penile cancer. Even more relevant globally is protection from cervical cancer, which is 10-times more common, being much higher in women with uncircumcised male partners. Male circumcision also provides indirect protection against various other infections in women, along with direct protection for men from a number of genital tract infections, including HIV. Given that adverse consequences of medical male circumcision, especially when performed in infancy, are rare, this simple prophylactic procedure should be promoted.
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Affiliation(s)
- Brian J. Morris
- School of Medical Sciences and Bosch Institute, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
| | - Ronald H. Gray
- Population and Family Planning, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Xavier Castellsague
- Institut Català d'Oncologia (ICO), IDIBELL, CIBERESP, RTICC, 08908 L'Hospitalet de Llobregat, Catalonia, Spain
| | - F. Xavier Bosch
- Institut Català d'Oncologia (ICO), IDIBELL, CIBERESP, RTICC, 08908 L'Hospitalet de Llobregat, Catalonia, Spain
| | - Daniel T. Halperin
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA 02115, USA
| | - Jake H. Waskett
- Circumcision Independent Reference and Commentary Service, Radcliffe, Manchester M261JR, UK
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Oertell J, Caballero C, Iglesias M, Chaux A, Amat L, Ayala E, Rodríguez I, Velázquez EF, Barreto JE, Ayala G, Cubilla AL. Differentiated precursor lesions and low-grade variants of squamous cell carcinomas are frequent findings in foreskins of patients from a region of high penile cancer incidence. Histopathology 2011; 58:925-33. [DOI: 10.1111/j.1365-2559.2011.03816.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bigot P, Longvert C. [Penile dermatological lesions: how to identify premalignant lesions?]. Prog Urol 2011; 21 Suppl 2:S50-2. [PMID: 21397829 DOI: 10.1016/s1166-7087(11)70011-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Penile squamous cell carcinoma is a highly evolving tumor. Thus an early diagnosis is a major matter in order to avoid tumoral spread and mutilating surgery. Intra-epithelial neoplasia is a carcinoma in situ involving a disorganized cytological structure and intraepithelial architecture without any change on the derma. It has a bimodal pathogenesis: it can be induced by papilloma virus HPV infection and thus Bowen's disease or Bowenoïd papulosis, or by a lichen sclerosus. Bowen's disease concerns mainly men after 50 years old. There are not any spontaneous remission and it transforms slowly in 20-30% of the cases into a squamous cell carcinoma. Its treatment is surgical removal of the lesion. The Bowenoïd papulosis concerns mainly young men. These lesions are rarely invasive and are likely to regress spontaneously. It can be treated conservatively. The lichen sclerosis is an inflammatory chronic disease which etiology is still unknown. It is localized on the glans and the prepuce. Its treatment is essentially circumcision. After treatment, patients must be followed-up and biopsies must be performed for any sign of degeneration.
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Affiliation(s)
- P Bigot
- Service d'Urologie, CHU d'Angers, 4 rue Larrey, 49933 Angers Cedex, France.
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Becker K. Lichen sclerosus in boys. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:53-8. [PMID: 21307992 DOI: 10.3238/arztebl.2011.053] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Accepted: 03/08/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lichen sclerosus (LS) is a sclerosing skin disease. When it appears in boys, it nearly always affects the penis and usually causes phimosis requiring surgical treatment. The clinical significance of this disease in boys is inadequately recognized. METHODS The etiology, clinical manifestations, diagnosis, and treatment of LS in boys are presented in the light of a review of selected literature. We also present our own experience with this disease in an ambulatory pediatric surgery practice. RESULTS LS has long been recognized as a disease of the prepubertal male genitalia (in such cases, the condition is also called "balanitis xerotica obliterans"). It is thought to be the main cause of acquired phimosis, and it can also involve the meatus and urethra as it progresses. Its possible association with squamous cell carcinoma of the penis remains unclear. Its etiology is unknown; its pathophysiological mechanism involves T-lymphocyte-mediated inflammation. The treatment of choice is complete circumcision. There is still controversy regarding the conservative treatment of LS with topical steroids. CONCLUSION LS is much more common in boys than is generally assumed. Lichen sclerosus should be suspected in any case of acquired phimosis. Treatment with complete circumcision does not necessarily bring about a definitive cure. Further research on the pathogenesis of this disease is needed.
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Affiliation(s)
- Karl Becker
- Kinderchirurgische Praxis, Prinz-Albert-Str. 26, 53113 Bonn, Germany.
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58
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Neill SM, Lewis FM, Tatnall FM, Cox NH. British Association of Dermatologists’ guidelines for the management of lichen sclerosus 2010. Br J Dermatol 2010; 163:672-82. [PMID: 20854400 DOI: 10.1111/j.1365-2133.2010.09997.x] [Citation(s) in RCA: 216] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- S M Neill
- St John's Institute of Dermatology, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
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Minhas S, Manseck A, Watya S, Hegarty PK. Penile cancer--prevention and premalignant conditions. Urology 2010; 76:S24-35. [PMID: 20691883 DOI: 10.1016/j.urology.2010.04.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 04/09/2010] [Accepted: 04/09/2010] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Relatively little evidence is available in the published studies on the prevention of penile cancer and premalignant conditions of the penis. The present review examined the current evidence available in preventing penile cancer and pathologic subtypes of premalignant conditions and their treatment. The recommendations made in the present review formulate the basis of the recent 2009 International Consultation on Urologic Disease Consensus Publishing Group. METHODS The association of human papillomavirus subtypes and penile cancer is well-established, although the etiology, natural history, and treatment of premalignant lesions have mainly been reported in retrospective case series with short-term follow-up. The exact pathologic role of chronic inflammatory conditions, such as balanitis xerotica obliterans in the etiology of penile cancer remains largely unknown. RESULTS Some of the potential strategies for the prevention of penile cancer could include circumcision, reducing the risk of transmission of penile human papillomavirus infection with male vaccination, early treatment of phimosis, smoking cessation, and hygienic measures. Implementing some of these measures would require extensive cost/benefit analysis, with significant changes in the global health policy. CONCLUSIONS Owing to the current levels of evidence from published studies, firm guidelines cannot be formulated for the treatment of premalignant conditions, although preventative measures, such as reducing human papillomavirus transmission, could become strategic health targets.
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Affiliation(s)
- Suks Minhas
- Institute of Urology, Division of Surgical and Interventional Sciences, University College London, 25 Grafton Way, London, United Kingdom.
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Crispen PL, Mydlo JH. Penile Intraepithelial Neoplasia and Other Premalignant Lesions of the Penis. Urol Clin North Am 2010; 37:335-42. [DOI: 10.1016/j.ucl.2010.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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61
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Les lésions précancéreuses du pénis. Ann Dermatol Venereol 2010; 137:486-92; quiz 485, 493-4. [DOI: 10.1016/j.annder.2010.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Accepted: 03/12/2010] [Indexed: 11/20/2022]
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Analysis of alterations adjacent to invasive squamous cell carcinoma of the penis and their relationship with associated carcinoma. J Am Acad Dermatol 2010; 62:284-90. [DOI: 10.1016/j.jaad.2009.06.087] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 06/11/2009] [Accepted: 06/25/2009] [Indexed: 11/18/2022]
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Wang SH, Chi CC, Wong YW, Salim A, Manek S, Wojnarowska F. Genital verrucous carcinoma is associated with lichen sclerosus: a retrospective study and review of the literature. J Eur Acad Dermatol Venereol 2009; 24:815-9. [PMID: 20015174 DOI: 10.1111/j.1468-3083.2009.03531.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The association of lichen sclerosus (LS) with genital squamous cell carcinoma is well recognized. However, the relationship between LS and verrucous carcinoma remains unclear. OBJECTIVE To evaluate the associations of genital and perianal verrucous carcinomas with LS. METHODS We conducted a retrospective study on patients with a genital or perianal verrucous carcinoma and reviewed their histopathology specimens and clinical notes. We also conducted a literature review. RESULTS We identified a total of 13 patients (including 6 women and 7 men) with a genital or perianal verrucous carcinoma. All 5 women with vulval verrucous carcinoma had coexisting LS (5/5), and 1 man with penile verrucous carcinoma had coexisting LS (1/3). In contrast, no coexisting LS was found in all 5 cases of perianal verrucous carcinoma (0/5). Half of the cases of verrucous carcinoma with coexisting LS had recurrences (3/6), while no recurrences were found in those without coexisting LS (0/7). CONCLUSIONS Our study and review of the literature demonstrate that vulval verrucous carcinoma is strongly associated with LS. In contrast, perianal verrucous carcinoma is not associated with LS. When genital verrucous carcinoma is diagnosed, it is important to consider LS as a potential concomitant diagnosis and offer appropriate treatments and close follow-up to detect recurrence of verrucous carcinoma.
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Affiliation(s)
- S-H Wang
- Department of Dermatology, Oxford Radcliffe Hospitals, Oxford, UK
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Chaux A, Lezcano C, Cubilla AL, Tamboli P, Ro J, Ayala A. Comparison of Subtypes of Penile Squamous Cell Carcinoma From High and Low Incidence Geographical Regions. Int J Surg Pathol 2009; 18:268-77. [DOI: 10.1177/1066896909339184] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
There is a worldwide geographical variation in the incidence of penile squamous cell carcinoma (PSCC); some subtypes are HPV-related (warty, basaloid) while others (keratinizing variants) are not. The aims of this study were to compare the distribution of different histological subtypes of PSCC from regions of low (Paraguay, 144 cases) and high (USA, 157 cases) incidence and to identify and compare tumors with and without warty and/or basaloid morphology. The distribution of subtypes in the Paraguayan and the American series was: usual, 49.3 and 46.5%; verrucous, 8.3 and 7.6%; papillary NOS, 7.6 and 5.7%; warty, 6.9 and 8.3%; basaloid, 4.2 and 7.0%; sarcomatoid, 0.7 and 0.6%; adenosquamous, 3.5 and 0.6%; and mixed, 19.4 and 23.6%, respectively. The distribution of mixed PSCC was: warty-basaloid, 50.0 and 59.5%; usual-verrucous, 21.4 and 21.6%; usual-warty, 14.3 and 8.1%; usual-basaloid, 7.1 and 0.0%; usual-papillary, 3.6 and 5.4%; and others, 3.6 and 5.4%, respectively. In conclusion, we found no geographical difference in the incidence of histological subtypes ( p = 0.6501), mixed PSCC ( p = 0.5937) or HPV-related tumors ( p = 0.2505). Geographical variation may be the result of staging variation at clinical presentation or of pathological diagnosis. The identification of similar histological subtypes in both series validates this classification approach for penile cancer. The tendency for typical SCC to mix with verrucous and papillary carcinomas and of the basaloid to preferentially mix with benign condyloma and condylomatous (warty) carcinomas would support the hypothesis of the existence of an etiologically different dual population of penile tumors.
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Affiliation(s)
- Alcides Chaux
- Instituto de Patología e Investigación, Asunción, Paraguay
| | | | | | | | - Jae Ro
- Methodist Hospital, Houston, Texas
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Affiliation(s)
- Nitin Ranjan
- Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College, Aligarh Muslim University (AMU), Aligarh, India.
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Abstract
This article provides comprehensive review of benign diseases and neoplastic conditions of the penis. It describes and provides representative images of clinical, key pathologic features and ancillary techniques to aid in differential diagnoses. It examines these diseases from the epidemiologic standpoint, looks at environmental and genetic factors, and outlines the new histologic entities for penile neoplasms with distinct outcomes and clinical behavior that have been proposed in recent years.
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Affiliation(s)
- Matthew J Wasco
- Department of Pathology, University of Michigan, 1500 East Medical Center Drive, 2G332 UH, Ann Arbor, MI 48109, USA
| | - Rajal B Shah
- Department of Pathology, University of Michigan, 1500 East Medical Center Drive, 2G332 UH, Ann Arbor, MI 48109, USA; Department of Urology, University of Michigan, 1500 East Medical Center Drive, 2G332 UH, Ann Arbor, MI 48109, USA.
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67
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68
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Au WY, Yeung CK, Cheung MC, Trendell-Smith N. Penile lichen sclerosus after allogeneic stem cell transplantation. Br J Dermatol 2008; 159:470-472. [DOI: 10.1111/j.1365-2133.2008.08645.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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69
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Scheiner MA, Campos MM, Ornellas AA, Chin EW, Ornellas MH, Andrada-Serpa MJ. Human papillomavirus and penile cancers in Rio de Janeiro, Brazil: HPV typing and clinical features. Int Braz J Urol 2008; 34:467-74; discussion 475-6. [DOI: 10.1590/s1677-55382008000400009] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2008] [Indexed: 08/30/2023] Open
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70
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Penile cancer: epidemiology, pathogenesis and prevention. World J Urol 2008; 27:141-50. [DOI: 10.1007/s00345-008-0302-z] [Citation(s) in RCA: 237] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Accepted: 06/09/2008] [Indexed: 11/25/2022] Open
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Abstract
Lichen sclerosus is a chronic mucocutaneous inflammatory condition affecting both adults and children in a bimodal age distribution. Children can present as young as 6 months of age but average around 5 years. Females present with vulvar itching, soreness, dysuria, or gastrointestinal complaints, while males tend to have difficulty retracting the foreskin leading to phimosis. On examination, white smooth atrophic plaques are found in the anogenital region with atrophy and possible distortion of anatomy. LS in children has been commonly misdiagnosed as sexual abuse, leading to delay in appropriate diagnosis and unnecessary turmoil for families. It is a chronic relapsing and remitting condition possibly due to autoimmunity. When evaluating patients, a complete history can help guide which patients may benefit from a systemic evaluation for autoimmune disease. Although some patients have spontaneous resolution during puberty, many do not. There is a significant risk of squamous cell carcinoma developing in genital LS in adults possibly from chronic inflammation, delay in diagnosis, and delay in appropriate treatment. The risk of squamous cell carcinoma in pediatric onset LS is undefined. It is also unclear if effective control of cutaneous inflammation can decrease the risk of malignant transformation. Treatment is aimed at decreasing symptoms and returning involved skin to its normal appearance. Relapses are common. Ultrapotent topical corticosteroids are first line for the treatment of LS and can be used intermittently for years for flares. Topical tacrolimus or pimecrolimus are also good treatment options at controlling inflammation. Patients need to be monitored every 6 to 12 months even when asymptomatic because of the potential for development of malignancy. Given the distressing nature of LS, support groups and a multidisciplinary approach are recommended.
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Affiliation(s)
- Gabriele Poindexter
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
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72
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Prowse DM, Ktori EN, Chandrasekaran D, Prapa A, Baithun S. Human papillomavirus-associated increase in p16INK4A expression in penile lichen sclerosus and squamous cell carcinoma. Br J Dermatol 2007; 158:261-5. [PMID: 18047520 PMCID: PMC2268980 DOI: 10.1111/j.1365-2133.2007.08305.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Human papillomaviruses (HPVs) are sexually transmitted human carcinogens that may play a role in the oncogenesis of penile cancer. Objectives To investigate the role of HPV infection and expression of the tumour suppressor protein p16INK4A in the pathogenesis of penile cancer. Methods By means of polymerase chain reaction amplification and reverse hybridization line probe assay to detect HPV infection, and immunohistochemical staining for p16INK4A and Ki67, we analysed 26 penile squamous cell carcinomas (SCCs) and 20 independent penile lichen sclerosus (LS) lesions from 46 patients. Results HPV DNA was found in 54% of penile SCCs and 33% of penile LS cases in single and multiple infections. High-risk HPV 16 was the predominant HPV type detected. No relationship between Ki67 expression and HPV infection was observed. Strong immunostaining for p16INK4A correlated with HPV 16/18 infection in both penile LS and penile SCC. In our penile SCC series the cancer margins were also associated with penile LS in 13 of 26 lesions, and HPV was detected in seven of the 13 SCC cases associated with LS and in six of the 11 SCC lesions not involving LS. Conclusions Our study shows a high prevalence of HPV 16 and p16INK4A expression in penile lesions, consistent with an active role for HPV in interfering with the retinoblastoma pathway. High-risk HPV infection could be involved in the tumorigenic process in 50% of penile cancers, and the use of prophylactic HPV vaccines has the potential to prevent these cancers.
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Affiliation(s)
- D M Prowse
- Centre for Molecular Oncology, Institute of Cancer, Bart's and The London Queen Mary's School of Medicine and Dentistry, John Vane Science Centre, Charterhouse Square, London EC1M 6BQ, UK.
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73
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Pugliese JM, Morey AF, Peterson AC. Lichen sclerosus: review of the literature and current recommendations for management. J Urol 2007; 178:2268-76. [PMID: 17936829 DOI: 10.1016/j.juro.2007.08.024] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE We reviewed the literature regarding the clinical presentation, etiology, natural history, and medical and surgical management of lichen sclerosus in men. MATERIALS AND METHODS We performed a comprehensive search of the literature in PubMed, MEDLINE and other electronic databases between 1950 and 2006 using the key words lichen sclerosis, balanitis xerotica obliterans and urethral stricture. Our search resulted in 1,268 sources containing the words lichen sclerosus or balanitis xerotica obliterans. We reviewed 68 articles in the peer reviewed journals and 2 chapters on this subject. RESULTS Lichen sclerosus is a chronic, lymphocyte mediated skin disease that was first described in 1887. It shows a predilection for the anogenital area in men and women. Much has been discovered regarding the epidemiology, natural history and histological features of this disease process during the last century, including the discovery of a strong association between lichen sclerosus and squamous cell carcinoma. The techniques of medical and surgical management of this disorder are still being elucidated. Biopsy of the initial lesion for definitive diagnosis and long-term followup of affected patients are well established, critical elements in the management of lichen sclerosus. CONCLUSIONS Lichen sclerosus is a chronic, debilitating condition that may progress to cause significant voiding complications. Biopsy is recommended in all patients suspected of having lichen sclerosus to rule out squamous cell carcinoma. Further research is needed to improve the prevention, understanding and treatment of this challenging condition.
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Affiliation(s)
- Jennifer M Pugliese
- Department of Surgery, Urology Service, Madigan Army Medical Center, Tacoma, Washington 98431, USA
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74
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Calcagno C. Balanitis Xerotica Obliterans. Urologia 2007. [DOI: 10.1177/039156030707400403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Balanitis xerotica obliterans (BXO), first described by Stuhmer in 1928, is a chronic, progressive, atrophic, sclerosing process involving prepuce, glans and urethra. Its aetiology is unknown. After a short terminological excursus and a review of the aetiological hypothesis, we have focused on BXO in daily urological practice. We are here describing the clinical presentation and its differential diagnosis with premalignant and malignant lesions of the penis. We tried to define the relationship between BXO and squamous cell carcinoma of the penis. Particular attention was then cast on urethral stenosis. Finally, we focused on the treatment of BXO: corticosteroid local therapy as first line treatment or as adjuvant therapy after circumcision, surgical therapy including circumcision, laser therapy of the glans lesions, meatoplasty in the stenosis of the anterior urethra. We also stressed the need for histological examination of the preputial specimen for a correct follow-up and for medicolegal reasons.
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Affiliation(s)
- C. Calcagno
- Dipartimento di Urologia, Ospedale San Carlo, Genova-Voltri
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75
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Van Howe RS. Human papillomavirus and circumcision: A meta-analysis. J Infect 2007; 54:490-6. [PMID: 16997378 DOI: 10.1016/j.jinf.2006.08.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2006] [Revised: 07/11/2006] [Accepted: 08/08/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND Determine the relationship of circumcision status to the risk for genital infection with human papillomavirus (HPV). METHODS A MEDLINE search and a review of references in published articles were used to identify publications from peer-reviewed journals in Index Medicus with data on circumcision status in patients with and without HPV infections. Inclusion criteria included diagnosis by culture, biopsy, or PCR, determination of circumcision status by physical examination, and multiple site sampling including the shaft of the penis. A meta-analysis was performed with sensitivity analyses. RESULTS Sixteen articles contained data on circumcision status in patients with and without HPV infections. Eight studies used accurate diagnostic methods. Only three articles satisfied the strict inclusion criteria. There was no significant association between circumcision status and HPV infection (random-effects model summary effect OR=1.20, 95%CI=0.80-1.79) in these three studies. If the eight studies using accurate diagnostic methods are adjusted for the method of determining circumcision status and failure to sample the penile shaft using meta-regression the summary effects odds ratio is 1.25 (95%CI=0.95-1.67). CONCLUSIONS The medical literature does not support the claim that circumcision reduces the risk for genital HPV infection. To correctly assess the risk of HPV infection in circumcised males, the penile shaft needs to be sampled for HPV infection.
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Affiliation(s)
- Robert S Van Howe
- Department of Pediatrics, Michigan State University College of Human Medicine, 1414 W. Fair Avenue, Suite 226, Marquette, MI 49855, USA.
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76
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Palminteri E, Berdondini E, Lazzeri M, Mirri F, Barbagli G. Resurfacing and reconstruction of the glans penis. Eur Urol 2007; 52:893-8. [PMID: 17275169 DOI: 10.1016/j.eururo.2007.01.047] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2006] [Accepted: 01/12/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe the techniques and results of surgical reconstruction of glans penis lesions. METHODS Seventeen patients (mean age: 53.2 yr) were treated by resurfacing or reconstruction of the glans penis for benign, premalignant and malignant penile lesions. The aetiology of the lesions was one Zoon's balanitis, four lichen sclerosus, one carcinoma in situ, five squamous cell carcinomas, and six squamous cell carcinomas associated with lichen sclerosus. Five cases were treated by glans skinning and resurfacing; five cases by glans amputation and reconstruction of the neoglans, and seven cases by partial penile amputation and reconstruction of the neoglans. Glans resurfacing and reconstruction were performed with the use of a skin graft harvested from the thigh. RESULTS The mean follow-up was 32 mo. All patients were free of local premalignant/malignant recurrence. Patients who underwent glans resurfacing reported glandular sensory restoration and complete sexual ability. Patients who underwent glansectomy or partial penectomy with neoglans reconstruction maintained sexual function and activity, although sensitivity was reduced as a consequence of glans/penile amputation. CONCLUSIONS In selected cases of benign, premalignant or malignant penile lesions, glans resurfacing or reconstruction can ensure a normal appearing and functional penis, without jeopardizing cancer control.
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Affiliation(s)
- Enzo Palminteri
- Center for Urethral and Genitalia Reconstructive Surgery, Arezzo, Italy.
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77
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Windahl T. Is carbon dioxide laser treatment of lichen sclerosus effective in the long run? ACTA ACUST UNITED AC 2006; 40:208-11. [PMID: 16809261 DOI: 10.1080/00365590600589666] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the long-term results after carbon dioxide laser treatment of lichen sclerosus. MATERIAL AND METHODS We evaluated 62 consecutive patients with histologically verified lichen sclerosus admitted between 1985 and 1991. All patients were treated with a carbon dioxide laser with an output of 15-20 W and a defocused beam. This treatment vaporized the macroscopically altered area of the glans penis. Phimosis and superficial meatal stenosis were treated at the same session. Fifty-three men were still alive in 2004, and we were able to contact 50 of them (94%). The patients were asked about recurrence of symptoms, any visible penile lesion and recurrence of meatal stenosis. All patients who reported symptoms were invited to visit the outpatient clinic for further examination. RESULTS The median follow-up time was 14 years. At follow-up, 40 patients (80%) had no local symptoms and no visible lesion. Ten patients had minor symptoms but only two required further treatment. CONCLUSION Long-term follow-up of carbon dioxide laser treatment of lichen sclerosus shows that the treatment is safe and gives good results.
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Affiliation(s)
- T Windahl
- Department of Urology, University Hospital, Orebro, Sweden.
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78
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Abstract
BACKGROUND Data on the prevalence of human papillomavirus (HPV) infection in patients with penile lichen sclerosus (LS) are scant and controversial. AIM To investigate the prevalence of HPV infections in patients with penile LS. METHODS HPV infection was assessed by polymerase chain reaction (PCR) in paraffin-embedded penile biopsies obtained from the glans or inner foreskin of 46 adult patients with penile LS, and in brush cytology smears of penile healthy mucosa from an equal number of randomly selected control males matched for age. Statistical evaluation was performed using conditional logistic regression analysis. RESULTS PCR disclosed the presence of HPV infection in 17.4% of LS patients (HPV 16, six cases; HPV 18, one case; HPV 45, one case). Amongst the controls, HPV infection occurred in 8.7% of patients (HPV 16, two cases; HPV 53, one case; HPV 70, one case). Statistical regression analysis confirmed that the rate of HPV infection was higher amongst patients with genital LS than amongst healthy controls [odds ratio (OR), 2.55; 95% confidence interval (CI), 0.73-8.89]. CONCLUSIONS Infection with oncogenic "high-risk" HPV types in patients with genital LS may enhance the risk of penile cancer arising on LS.
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79
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Pietrzak P, Hadway P, Corbishley CM, Watkin NA. Is the association between balanitis xerotica obliterans and penile carcinoma underestimated? BJU Int 2006; 98:74-6. [PMID: 16831147 DOI: 10.1111/j.1464-410x.2006.06213.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the incidence of balanitis xerotica obliterans (BXO) in a consecutive series of penile carcinomas in one centre, as BXO is a common penile disease that usually involves the prepuce and glans, and there have been sporadic case reports of the association between BXO and penile carcinoma, although it is uncertain if there is a specific causal relationship. PATIENTS AND METHODS The reported incidence of penile carcinoma in patients with BXO is 2.6-5.8%, leading some to advocate circumcision in all cases, with close follow-up in those with persistent glanular disease. We prospectively analysed all cases of penile cancer referred to the unit over a 54-month period, to determine the prevalence of BXO. RESULTS In all, 155 patients with penile malignancy were reviewed, 44 of whom had BXO (28%). This group included 34 men with squamous cell carcinoma and 10 with carcinoma in situ; in 39, BXO and malignancy presented synchronously. In three other cases, cancer occurred in the background of chronic persistent BXO; in two cases penile cancer was truly metachronous. The tumours with associated BXO tended to be of lower stage and grade, and the patients presented when younger, but this was not statistically significant. CONCLUSION A significant proportion of patients with penile malignancy have a histological diagnosis of BXO. We think that patients presenting with long-standing BXO and those in whom BXO has not resolved after circumcision warrant biopsies and a careful follow-up.
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Affiliation(s)
- Peter Pietrzak
- Department of Urology, St George's Hospital, Tooting, London, UK
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80
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Enoch S, Miller DR, Price PE, Harding KG. Early diagnosis is vital in the management of squamous cell carcinomas associated with chronic non healing ulcers: a case series and review of the literature. Int Wound J 2006; 1:165-75. [PMID: 16722875 PMCID: PMC7951595 DOI: 10.1111/j.1742-4801.2004.00056.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The association between chronic ulcers and squamous cell carcinomas (SCCs) is well established. Their clinical presentations, however, are varied, ranging from innocously appearing lesions to overtly exophytic growths. We present a series of cases with heterogeneous clinical presentations and different treatment outcomes. Case series - patient 1 was a 69-year-old man with an 18-month history of static non healing venous leg ulcer, but no sinister features, biopsy was performed to rule out Marjolin's transformation, histology revealed SCC and treatment was simple excision and skin grafting; patient 2 was a 73-year-old lady with an 18-month history of non healing ulcer (innocuous appearance) over distal interphalangeal joint of index finger, histology revealed SCC with deeper extension and treatment was amputation of distal half of finger; patient 3 was a 73-year-old lady with a 12-month history of non healing fungating leg ulcer with irregular borders and everted edges, histology revealed SCC (tumour eroding tibia and distant metastasis) and treatment was above-knee amputation, radiotherapy and palliation. Whilst SCC is amenable to simple excision in the early stages, delay in diagnosis could result in loss of the affected digit or limb; an SCC which has metastasised is also life threatening. Therefore, a low threshold to biopsy static non healing ulcers or ulcers in unusual sites should be adopted even in those not manifesting any evidence of malignancy.
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Affiliation(s)
- Stuart Enoch
- Clinical Research Fellow, Wound Healing Research Unit, University of Wales College of Medicine, Cardiff CF14 4NX, UK
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81
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Barbagli G, Palminteri E, Mirri F, Guazzoni G, Turini D, Lazzeri M. Penile Carcinoma in Patients With Genital Lichen Sclerosus: A Multicenter Survey. J Urol 2006; 175:1359-63. [PMID: 16515998 DOI: 10.1016/s0022-5347(05)00735-4] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE In this observational descriptive study we reviewed the histology and the clinical records of 130 patients with LS involving the male genitalia to determine the presence of premalignant or malignant lesions. MATERIALS AND METHODS A total of 130 male patients (from 1991 to 2001) with genital LS were treated at our centers. Mean patient age at diagnosis was 42.5 years. In all patients with a clinical diagnosis of LS, the histology was reexamined to look for evidence of LS, applying strict histological criteria. All cases of histologically proven epithelial malignancy, namely SCC, VC and EQ, were reviewed to confirm the presence of neoplastic changes and ascertain the degree of SCC differentiation. RESULTS Of 130 men 11 (8.4%) with genital LS showed premalignant or malignant histopathological features including 7 (64%) with SCC, 2 (18%) with VC, 1 (9%) with EQ and 1 (9%) with SCC associated with VC. In 6 of 11 patients (55%) the histological study showed the presence of epithelial dysplasia. CONCLUSIONS Survival of patients with penile carcinoma depends on early diagnosis and treatment, and all patients with genital LS should be observed closely to detect the development of neoplastic or preneoplastic lesions as early as possible.
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Affiliation(s)
- G Barbagli
- Center for Urethral and Genitalia Reconstructive Surgery, Florence, Italy
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82
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Micali G, Nasca MR, Innocenzi D, Schwartz RA. Penile cancer. J Am Acad Dermatol 2006; 54:369-91; quiz 391-4. [PMID: 16488287 DOI: 10.1016/j.jaad.2005.05.007] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2004] [Revised: 03/30/2005] [Accepted: 05/03/2005] [Indexed: 11/24/2022]
Abstract
UNLABELLED Penile cancer, while relatively rare in the western world, remains a disease with severe morbidity and mortality, not to mention significant psychological ramifications. Furthermore, the disease is observed with dramatically increased incidence in other parts of the world. A review of the literature has shown that the overwhelming majority of penile cancers are in situ or invasive squamous cell carcinomas, including a well-differentiated variant, verrucous carcinoma. Important predisposing factors are lack of circumcision, human papillomavirus infections, and penile lichen sclerosus, although other factors have occasionally been reported as well. Prevention, careful monitoring of patients at risk, and early diagnosis are essential to reduce the incidence of penile carcinoma and to provide a definitive cure. Public health measures, such as prophylactic use of circumcision, have proved successful but are controversial. Also, no standard therapeutic guidelines as to the best treatment strategy according to different stages, including efficacy of conservative nonsurgical modalities and indications for lymph nodal dissection, are available so far. It is common opinion that penile cancer is an emerging problem that deserves further investigations, and physicians, especially dermatologists, should be aware of this issue. LEARNING OBJECTIVE At the completion of this learning activity, participants should be familiar with penile carcinoma, its risk factors, its clinical and histologic presentation, and the treatments currently available for its management.
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Affiliation(s)
- Giuseppe Micali
- Department of Dermatology, University of Catania School of Medicine, Catania, Italy.
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83
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Kiss A, Király L, Kutasy B, Merksz M. High incidence of balanitis xerotica obliterans in boys with phimosis: prospective 10-year study. Pediatr Dermatol 2005; 22:305-8. [PMID: 16060864 DOI: 10.1111/j.1525-1470.2005.22404.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This prospective study was designed to address the incidence and clinical and histologic characteristics of balanitis xerotica obliterans in a large random pediatric population with phimosis. We investigated 1178 boys who presented consecutively with phimosis between 1991 and 2001. All patients who underwent complete circumcision and surgical specimens were typed histologically as early, intermediate, or late forms of this disorder or as nonspecific chronic inflammation. Patients with balanitis xerotica obliterans were controlled at 1, 6, and 12 months postoperatively, then yearly. Balanitis xerotica obliterans was found in 471 of the 1178 patients (40%), with the highest incidence in boys aged 9 to 11 years (76%). Secondary phimosis occurred in 93% of boys with balanitis xerotica obliterans and in 32% of those without the disorder. In six instances of balanitis xerotica obliterans, meatotomy and in one meatoplasty was performed, as well as circumcision. On histologic evaluation, we found 19% had early, 60% intermediate, and 21% late form of balanitis xerotica obliterans. Glanular lesions disappeared completely within 6 months in 229 out of 231 patients. Our data strongly suggest that the true incidence of childhood balanitis xerotica obliterans is higher than previously assumed. Its incidence peaks in the 9 to 11 years age group, in whom secondary phimosis was almost exclusively caused by balanitis xerotica obliterans.
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Affiliation(s)
- András Kiss
- Department of Urology, Heim Pál Children's Hospital, Budapest, Hungary.
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84
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Peterson AC, Palminteri E, Lazzeri M, Guanzoni G, Barbagli G, Webster GD. Heroic measures may not always be justified in extensive urethral stricture due to lichen sclerosus (balanitis xerotica obliterans). Urology 2005; 64:565-8. [PMID: 15351594 DOI: 10.1016/j.urology.2004.04.035] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2004] [Accepted: 04/20/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Strictures due to lichen sclerosus (LS) may affect the urethra as far proximally as the mid-bulb. For such strictures, a staged full-length repair is required and should use a nonpenile graft source such as buccal mucosa. Many cases occur in a population already accustomed to seated voiding, leading us to re-evaluate this approach and, in some circumstances, recommend definitive perineal urethrostomy alone. METHODS We reviewed the medical records and retrograde urethrograms of all patients undergoing surgery for LS at our facilities between January 1991 and June 2002. RESULTS A total of 63 patients, with an average age of 54.2 years, underwent surgery for LS stricture with an average follow-up of 38.5 months (range 4 to 117). Of the 63 patients, 19 underwent grafting in preparation for future reconstruction. Of these, 11 completed the second-stage repair, and 8 patients elected not to undergo the second stage of the repair, leaving a functional perineal urethrostomy. This led us to look more critically at definitive perineal urethrostomy alone for some patients. Parallel with the staged repairs, and subsequent to them, 44 patients underwent perineal urethrostomy alone. CONCLUSIONS The often extensive nature of LS, the prevailing philosophy that urethroplasty must use nonpenile skin, the limited availability of such sources, and the acceptance of many patients for seated voiding makes definitive perineal urethrostomy alone a viable treatment option. In all our cases, this satisfied patients' quality of life concerns, leaving the anterior urethra dry and amenable to future repair. Younger men desirous of penile voiding should still be considered for staged repair using current techniques.
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Affiliation(s)
- Andrew C Peterson
- Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
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85
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Pseudohyperplastic Squamous Cell Carcinoma of the Penis Associated With Lichen Sclerosus. AJSP-REVIEWS AND REPORTS 2005. [DOI: 10.1097/01.pcr.0000153238.49393.ac] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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86
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Peterson AC, Webster GD. Management of urethral stricture disease: developing options for surgical intervention. BJU Int 2004; 94:971-6. [PMID: 15541111 DOI: 10.1111/j.1464-410x.2004.05088.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Andrew C Peterson
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, North Carolina, USA.
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87
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Ena P, Lorrai P, Pintus A, Marras V, Dessy LA. Development of multifocal squamous cell carcinoma in lichen sclerosus et atrophicus of the penis associated to HCV hepatitis. Andrologia 2004; 36:38-40. [PMID: 14871263 DOI: 10.1046/j.1439-0272.2003.00600.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We describe the case of a 59-year-old uncircumcised man, with a history of meatal stenosis and balanitis xerotica obliterans (lichen sclerosus et atrophicus) and human C virus hepatitis, who developed an infiltrating squamous cell carcinoma of the penis. The relationship among these conditions is discussed.
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Affiliation(s)
- P Ena
- Department of Dermatology, University of Sassari, Italy.
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88
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Invasive Penile Carcinoma. Dermatol Surg 2004. [DOI: 10.1097/00042728-200402002-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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89
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Abstract
BACKGROUND Penile carcinoma is an invasive epithelial tumor that may arise from penile skin or mucosa. OBJECTIVE To review the pathogenesis and the clinical and histopathologic features of invasive penile carcinomas, with emphasis on current guidelines for their diagnosis and treatment. METHODS Information available from the authors' clinical experience, review articles, case reports, clinical trials, and in vitro research studies identified from a computerized literature search on MEDLINE database and from Meetings' Abstract Books, including those from non-English literature, was considered. RESULTS Penile cancer may develop de novo or in association with underlying factors. Conditions predisposing to the development of penile cancer are delineated. The diagnosis should be suspected by clinical findings and must be confirmed histologically. Imaging techniques may be useful for staging and planning therapy. Therapeutic options include excisional surgery, laser destruction, cryosurgery, radiotherapy, immunotherapy, and chemotherapy. CONCLUSIONS Although there are no current guidelines for the treatment of penile carcinoma, surgical ablation probably represents the best option, as conservative treatments still deserve cautious evaluation because of the relatively small number of treated patients and the lack of good-quality comparative data. Regarding indications for lymph nodal dissection in patients showing no inguinal node enlargement, sentinel node mapping with targeted lymph node dissection is recommended for those with deeply invasive, high-grade tumors, whereas a watchful waiting may be advised for those with superficially invasive, low-grade tumors.
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Affiliation(s)
- Giuseppe Micali
- Dermatology Clinic, University of Catania Dermatology Clinic, University La Sapienza of Rome Department of Dermatology, New Jersey Medical School, Newark, New Jersey, USA.
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90
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Arlette JP, Trotter MJ. Squamous cell carcinoma in situ of the skin: History, presentation, biology and treatment. Australas J Dermatol 2004; 45:1-9; quiz 10. [PMID: 14961900 DOI: 10.1111/j.1440-0960.2004.00025.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Squamous cell carcinoma in situ (SCCIS) of the skin is a problem commonly dealt with by dermatologists. The classic presentation, originally described by Bowen, is easily recognized, but presentation on some anatomical surfaces may be associated with less than typical features. Major aetiological factors for this disease are UV light, human papillomavirus infection and immunosuppression. The natural course of SCCIS is usually prolonged, with treatment being appropriate, but not urgent. The choice of therapy requires consideration of the location of the lesion, and a desire for a high cure rate without causing loss of form, function or cosmesis. The immunomodulatory agent imiquimod has offered a significant advance for the topical treatment of SCCIS. Our improved understanding of the underlying biology of SCCIS permits us to make rational choices of treatment. In the future we may be able to determine which of these lesions may progress to invasive disease, and help us select the most effective therapy.
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Affiliation(s)
- John P Arlette
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada.
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91
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Abstract
Lichen sclerosus, an unusual chronic mucocutaneous condition of the penis, has been found in association with invasive penile cancer, and squamous cell carcinoma has been reported in patients with longstanding lichen sclerosus. The aim of this study was to determine the anatomic distribution and prevalence of lichen sclerosus in patients with squamous cell carcinoma of the penis and to search for a correlation with special types of carcinomas. Clinical and pathologic data from 207 penectomy and circumcision specimens with squamous cell carcinomas and giant condylomas were evaluated, and 68 patients with lichen sclerosus were identified. Mean age was 61 years. The preferential anatomic site of lichen sclerosus was the foreskin, but other sites (glans and coronal sulcus) including urethra were also involved. Grossly, the lesions showed white-gray smooth or irregular patches and plaques adjacent to invasive cancers. Microscopically, the lesion was stromal-epithelial with atrophic and hyperplastic epithelium and edematous or densely eosinophilic hyalinized lamina propria. A variable band of lymphocytic infiltration beneath the sclerosis was noted. Lichen sclerosus were preferentially associated with non-human papillomavirus variants of squamous cell carcinoma. When lichen sclerosus was associated with malignancy, it often showed, in addition to the hyperplastic epithelium, a low-grade squamous intraepithelial lesion. These findings suggest that lichen sclerosus may represent preneoplastic condition for at least some types of penile cancers, in particular those not related to human papillomavirus.
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Affiliation(s)
- Elsa F Velazquez
- Department of Pathology, New York University Medical Center, New York, USA.
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92
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Abstract
Bowen's disease of the skin may have differing clinical presentations depending on the skin surface on which it presents, but has the same histologic features of squamous cell carcinoma in situ wherever it occurs. The etiologic factors include ultraviolet light and human papillomavirus infection. The choice of therapy requires a consideration for retention of form, function and cosmosis while offering a high cure rate. The immunodualtory agent imiquimod has been shown to be an effective treatment on a variety of skin surfaces.
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93
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Sánchez-Ortiz RF, Pettaway CA. Natural history, management, and surveillance of recurrent squamous cell penile carcinoma:. Urol Clin North Am 2003; 30:853-67. [PMID: 14680320 DOI: 10.1016/s0094-0143(03)00055-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
For men with penile carcinoma, surveillance strategies may be tailored to the risks of local and regional recurrence, which vary according to the pathologic characteristics of the primary tumor and the modalities employed for local therapy (phallus sparing or extirpative) and regional therapy (surveillance or lymphadenectomy). Men at a higher risk for local or regional recurrence who should have more rigorous follow-up include those (1) treated with phallus-sparing strategies such as laser ablation, topical therapies, or radiotherapy; (2) patients with clinically negative inguinal lymph nodes who are managed without lymphadenectomy despite high-risk primary tumors (pT2-3, grade 3, vascular invasion); and (3) those with lymph node metastases after lymphadenectomy. Good candidates for less-stringent surveillance include patients with low-risk primary tumors (pTis, pTa, pT1, grades 1-2) and those with negative inguinal nodes after lymphadenectomy whose primary tumors were managed with partial or total penectomy.
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Affiliation(s)
- Ricardo F Sánchez-Ortiz
- Department of Urology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 446, Houston, TX 77030, USA
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94
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Nasca MR, Panetta C, Micali G, Innocenzi D. Microinvasive squamous cell carcinoma arising on lichen sclerosus of the penis. J Eur Acad Dermatol Venereol 2003; 17:337-9. [PMID: 12702081 DOI: 10.1046/j.1468-3083.2003.00742.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The case of a 70-year-old white man with a 10-year history of penile lichen sclerosus (LS) who developed microinvasive squamous cell carcinoma on LS is described. A high incidence of penile cancer arising on genital LS has recently been observed. The authors stress the importance of an adequate diagnosis and long-term follow-up in patients with penile LS because of the malignant potential of the disease.
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Affiliation(s)
- M R Nasca
- Clinica Dermatologica, Università di Catania, Piazza S Agata La Vetere 6, 95124 Catania, Italy.
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95
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Perceau G, Derancourt C, Clavel C, Durlach A, Pluot M, Lardennois B, Bernard P. Lichen sclerosus is frequently present in penile squamous cell carcinomas but is not always associated with oncogenic human papillomavirus. Br J Dermatol 2003; 148:934-8. [PMID: 12786823 DOI: 10.1046/j.1365-2133.2003.05326.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Penile squamous cell carcinoma (SCC) may occur on pre-existing lesions of lichen sclerosus (LS). However, the prevalence of histological changes of LS in penile SCC is not well established. Moreover, mucosal oncogenic human papillomaviruses (HPVs) are sometimes detected in penile SCC, but have not been systematically sought in LS-associated penile SCC. OBJECTIVES To establish the prevalence of LS histological changes and of mucosal oncogenic HPV in a series of patients with penile SCC. METHODS Consecutive cases of histologically proven penile SCC from a single university hospital over a 14-year period were retrospectively selected and reviewed. Histological signs of LS were systematically sought. HPV was detected by polymerase chain reaction (PCR) amplification of DNA from paraffin-embedded skin samples using general primers GP5+/GP6+ (allowing detection of mucosal HPV) and oncogenic type 16-, 18-, 31- and 33-specific primers. RESULTS Eighteen cases of penile SCC were found. The mean +/- SD age of patients at diagnosis was 67.3 (14.5 years). In eight of 18 (44%) cases, SCC was associated with histological features of LS. Seventeen skin biopsy specimens of SCC (nine without and eight with LS histology) were subjected to PCR amplification for HPV. Mucosal HPV was detected in six of them (35%). Five of nine SCCs without histological features of LS were positive for mucosal HPV: three with HPV type 16 and two with only general primers. In contrast, all eight SCCs associated with LS were negative for oncogenic HPV types, although one was positive with general primers. CONCLUSIONS Penile SCC seems to be frequently associated with LS histological changes. As with vulval SCC, we found that non-LS-associated penile SCC tended to be frequently associated with oncogenic HPV infection, whereas LS-associated penile SCC was not. Larger series are needed to confirm this association.
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Affiliation(s)
- G Perceau
- Department of Dermatology, Centre Hospitalier Universitaire Robert-Debré, Avenue du Maréchal Koenig, F-51092 Reims cedex, France
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96
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97
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Abstract
Lichen sclerosus is a chronic skin condition, which offers many challenges to the clinician. It affects men, women and children, and usually occurs in the anogenital area. The clinical signs can be confused with those seen in sexual abuse in children. The underlying cause is unknown; however, there is a strong association with autoimmune disorders, and immunogenetic studies have demonstrated a link with HLA DQ7. Patients suffer significant morbidity as a consequence of the intractable symptoms, physical scarring and psychosexual damage. Support groups may be helpful for some patients. Potent topical corticosteroids have been shown to be effective. There is a 5% incidence of squamous cell carcinoma, and all suspicious lesions should be biopsied. It is unclear whether the risk of malignancy is changed with the use of topical corticosteroids, as there is a potential risk of triggering a latent infection of human papillomavirus. A multidisciplinary approach to care is required and ideally all patients should attend a dedicated clinic and be offered long-term monitoring.
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Affiliation(s)
- G L Tasker
- Department of Dermatology, Oxford Radcliffe Hospital, Oxford, UK.
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98
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99
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Abstract
These guidelines for the management of lichen sclerosus have been prepared for dermatologists on behalf of the British Association of Dermatologists. They present evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiological aspects, diagnosis and investigation.
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Affiliation(s)
- S M Neill
- St Peter's Hospital, Chertsey, Surrey, UK
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Abstract
Lichen sclerosus is a depigmenting mucocutaneous disorder that most frequently affects the female genitalia. Lichen sclerosus affecting the oral mucosa is extremely rare. Oral lesions are asymptomatic but cosmetically unacceptable. We report here a case of lichen sclerosus presenting with a linear lesion over the nose that extended to involve the philtrum and the upper lip with intraoral extension up to the gingiva. Treatment with a short course of oral and intralesional corticosteroids resulted in partial resolution of the lesions.
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Affiliation(s)
- S Kaur
- Departments of Dermatology and Venereology and Pathology, Government Medical College and Hospital, Chandigarh, India
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