• balanitis sclerotica obliterans;
  • lichen sclerosus;
  • penile;
  • reconstruction;
  • squamous cell carcinoma

What's known on the subject? and What does the study add?

  • The European Association of Urology guidelines identify lichen sclerosus (LS) as a strong risk factor for penile squamous cell carcinoma (pSCC). However, this statement is based on the findings of case–control studies (Level of Evidence 2a) and a direct causal relationship between LS/balanitis xerotica obliterans (BXO) and pSCC remains to be established. Firm guidelines with respect to the appropriate follow-up policy for LS/BXO are lacking, whereas the impact of synchronous LS/BXO on the prognosis of pSCC remains to be determined.
  • The presence of histologically-confirmed synchronous LS/BXO in patients diagnosed with pSCC is relatively high, although it is not associated with an increased risk of adverse histopathological features. LS/BXO can develop in extragenital skin grafts used for reconstruction after organ-sparing surgery for pSCC.


  • To determine the rate of lichen sclerosus/balanitis xerotica obliterans (LS/BXO) in patients with penile squamous cell carcinoma (pSCC) and establish whether the presence of LS/BXO is associated with adverse histopathological features of pSCC.
  • To report the phenomenon of LS involving non-genital skin grafts in patients who underwent organ-sparing surgery and split-skin graft (SSG) reconstruction

Patients and Methods

  • Between January 2002 and January 2010, 223 men underwent surgical treatment for pSCC.
  • A group of 52 patients with histologically-confirmed synchronous LS was identified (group A; overall rate of LS/BXO = 23.3%) and compared with a group of patients without synchronous LS (group B; n = 171; 76.7%).
  • A subgroup of patients who underwent surgical excision and SSG reconstruction was also identified
  • The histology reports of graft biopsies obtained during follow-up were reviewed and the rate of LS involving the graft was also recorded.


  • Mean (range) age at diagnosis was 60.9 (34–81) years and 60.7 (28–89) years for groups A and B, respectively (P = 0.958).
  • The mean (range) duration of follow-up was 38.3 (4–92) months for group A and 45.5 (4–107) months for group B (P = 0.162)
  • No statistically significant differences were noted between groups A and B in terms of tumour grade (P = 0.091), stage (P = 0.697), presence of lymphovascular invasion (P = 0.333), histological subtype (P = 0.107), associated carcinoma in situ (P = 0.246) or nodal status at initial diagnosis (P = 0.555).
  • In the subgroup of 188 patients who underwent SSG reconstruction, 41 (21.8%) patients had histologically-confirmed synchronous LS; in this subgroup, 26 (13.8%) patients underwent graft biopsy during follow-up.
  • Genital LS involving the graft was identified in seven specimens, although none of these seven cases had associated recurrent pSCC.


  • The presence of histologically-confirmed synchronous LS in patients with pSCC is relatively high but is not associated with increased rates of adverse histopathological features, including carcinoma in situ.
  • LS can develop in extragenital skin grafts, although its association with the long-term risk for recurrent pSCC is not apparent in the present study.