High incidence of lichen sclerosus in patients with squamous cell carcinoma of the penis
Abstract
Background There is a well‐documented association between lichen sclerosus (LS) and vulval carcinoma in women; however, until recently, there have only been anecdotal reports of penile squamous cell carcinoma (SCC) occurring in men with LS.Objective The incidence of penile carcinoma occurring on a background of LS remains uncertain, and we wished to examine this possible association further.Method To address this, all the cases (n = 20) of penile SCC held on our pathology database (4 years) were examined. Histology was reviewed, blind to the clinical picture, for evidence of LS, applying strict histological criteria. Subsequently, clinical notes were reviewed for history of LS before the SCC presented, and history of previous circumcision, treatments, node involvement, metastases and death.Results In eight cases, evidence of LS was found in the excision specimen. Seven of these had well‐differentiated SCC. In the 12 cases with no evidence of LS, only three were well differentiated. With case note review, seven had a history of LS (four with histological LS), sometimes preceding the SCC by 10 years. These all had well‐differentiated SCC. Ten of the 20 patients are dead, seven from metastatic disease. Four deaths occurred in the ‘well‐differentiated LS’ group, but only one from penile SCC metastatic disease.Conclusions There appears to be a definite association between SCC of the penis and the presence of LS, similar to that reported between LS and vulval SCC in women. Of the 20 patients with penile SCC studied, 11 had a clinical history and/or histological evidence of LS. However, clinical presentation of the LS or need for circumcision may precede the SCC by many years. As follow‐up is impractical, counselling at the time of diagnosis is very important, and it is essential that medical practitioners are aware of this association so that the subsequent risk from SCC is reduced.
Number of times cited: 96
- Anthony Hall, Lichen Sclerosus, Atlas of Male Genital Dermatology, 10.1007/978-3-319-99750-6_19, (61-65), (2018).
- F.M. Lewis, F.M. Tatnall, S.S. Velangi, C.B. Bunker, A. Kumar, F. Brackenbury, M.F. Mohd Mustapa and L.S. Exton, British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018, British Journal of Dermatology, 178, 4, (839-853), (2018).
- Michael A. Granieri, Andrew C. Peterson and Ramiro J. Madden-Fuentes, Effect of Lichen Sclerosis on Success of Urethroplasty, Urologic Clinics of North America, 44, 1, (77), (2017).
- Hunter Wessells, Keith W. Angermeier, Sean Elliott, Christopher M. Gonzalez, Ron Kodama, Andrew C. Peterson, James Reston, Keith Rourke, John T. Stoffel, Alex J. Vanni, Bryan B. Voelzke, Lee Zhao and Richard A. Santucci, Male Urethral Stricture: American Urological Association Guideline, The Journal of Urology, 197, 1, (182), (2017).
- Francesco Casabona, Ilaria Gambelli, Federica Casabona, Pierluigi Santi, Gregorio Santori and Ilaria Baldelli, Autologous platelet-rich plasma (PRP) in chronic penile lichen sclerosus: the impact on tissue repair and patient quality of life, International Urology and Nephrology, 10.1007/s11255-017-1523-0, 49, 4, (573-580), (2017).
- Jie Zheng, Meng Pan, S. Gianfaldoni, A. M. D’Erme, T. Lotti, Xingqi Zhang, Peng Zhang, Jin Yuan, Qianjin Lu, Ken Hashimoto and Fiona Lewis, Autoimmune Dermatoses, Practical Immunodermatology, 10.1007/978-94-024-0902-4_13, (297-340), (2016).
- Niels V. Johnsen, Elizabeth T. Brown, W. Stuart Reynolds, Melissa R. Kaufman, Douglas F. Milam and Roger R. Dmochowski, Diagnosis and Management of Male Genital Lichen Sclerosus, Current Bladder Dysfunction Reports, 10.1007/s11884-016-0375-2, 11, 3, (234-241), (2016).
- Sarah R. Ottenhof, Maaike C. G. Bleeker, Daniëlle A. M. Heideman, Peter J. F. Snijders, Chris J. L. M. Meijer and Simon Horenblas, Epidemiology of Penile Cancer, Textbook of Penile Cancer, 10.1007/978-3-319-33220-8_1, (1-9), (2017).
- Kyle A. Burton, Kurt A. Ashack and Amor Khachemoune, Cutaneous Squamous Cell Carcinoma: A Review of High-Risk and Metastatic Disease, American Journal of Clinical Dermatology, 10.1007/s40257-016-0207-3, 17, 5, (491-508), (2016).
- Mahmoud Ziada, Christopher B Bunker and Asif Muneer, Premalignant penile lesions, Journal of Clinical Urology, 9, 4, (216), (2016).
- Christopher B. Bunker and William M. Porter, Dermatoses of the Male Genitalia, Rook's Textbook of Dermatology, Ninth Edition, (1-52), (2016).
- Dominic H. Tang, Peter E. Clark, Giovanna Giannico, Omar Hameed, Sam S. Chang and Lan L. Gellert, Lack of P16ink4a Over Expression in Penile Squamous Cell Carcinoma is Associated with Recurrence after Lymph Node Dissection, The Journal of Urology, 193, 2, (519), (2015).
- Lana X. Tong, Grace S. Sun and Joyce M.C. Teng, Pediatric Lichen Sclerosus: A Review of the Epidemiology and Treatment Options, Pediatric Dermatology, 32, 5, (593-599), (2015).
- K. Kühborth, G. Haidl and J.-P. Allam, Penile Dermatosen, Der Urologe, 54, 5, (684), (2015).
- Juan Carlos Regueiro Lopez, Enrique Gomez Gomez, Alberto Alonso Carrillo, Roque Cano Castiñeira and Maria Jose Requena Tapia, Perineostomy: the last oportunity, International braz j urol, 41, 1, (91), (2015).
- Laurence Stewart, Kurt McCammon, Michael Metro and Ramon Virasoro, SIU/ICUD Consultation on Urethral Strictures: Anterior Urethra—Lichen Sclerosus, Urology, 83, 3, (S27), (2014).
- C.A. Morton, A.J. Birnie and D.J. Eedy, British Association of Dermatologists' guidelines for the management of squamous cell carcinoma in situ (Bowen's disease) 2014, British Journal of Dermatology, 170, 2, (245-260), (2014).
- Susanna K. Fistarol and Peter H. Itin, Diagnosis and Treatment of Lichen Sclerosus, American Journal of Clinical Dermatology, 14, 1, (27), (2013).
- David Guerrero‐Setas, Noemí Pérez‐Janices, Amaya Ojer, Laura Blanco‐Fernandez, Carmen Guarch‐Troyas and Rosa Guarch, Differential gene hypermethylation in genital lichen sclerosus and cancer: a comparative study, Histopathology, 63, 5, (659-669), (2013).
- Prodromos Philippou, Majid Shabbir, David J. Ralph, Peter Malone, Raj Nigam, Alex Freeman, Asif Muneer and Suks Minhas, Genital lichen sclerosus/balanitis xerotica obliterans in men with penile carcinoma: a critical analysis, BJU International, 111, 6, (970-976), (2013).
- Kimberly L. Brady, Mary Gail Mercurio and Marc D. Brown, Malignant Tumors of the Penis, Dermatologic Surgery, 39, 4, (527-547), (2012).
- Sebastian Mannweiler, Stephan Sygulla, Elke Winter and Sigrid Regauer, Two major pathways of penile carcinogenesis: HPV-induced penile cancers overexpress p16ink4a, HPV-negative cancers associated with dermatoses express p53, but lack p16ink4a overexpression, Journal of the American Academy of Dermatology, 69, 1, (73), (2013).
- J. Kranz, P. Anheuser, H. Lichtenstein and J. Steffens, Urologische Dermatosen, Der Urologe, 52, 10, (1392), (2013).
- Pablo Boixeda, Lorea Bagazgoitia, João Borges da Costa and T. Truchuelo, Seltene entzündliche Hautveränderungen, Lasertherapie der Haut, 10.1007/978-3-642-29910-0_8, (111-129), (2012).
- Aikaterini Kyriakou, Christos Patsialas, Aikaterini Patsatsi and Dimitrios Sotiriadis, Treatment of male genital lichen sclerosus with clobetasol propionate and maintenance with either methylprednisolone aceponate or tacrolimus: a retrospective study, Journal of Dermatological Treatment, 24, 6, (431), (2013).
- Ather M. Abdelbaky, REPLY, BJU International, 109, 9, (E31-E32), (2012).
- Richard Edward Link, Cutaneous Diseases of the External Genitalia, Campbell-Walsh Urology, 10.1016/B978-1-4160-6911-9.00015-3, (436-467.e7), (2012).
- M. Gutiérrez-Pascual, F.J. Vicente-Martín and J.L. López-Estebaranz, Liquen escleroso y carcinoma escamoso, Actas Dermo-Sifiliográficas, 103, 1, (21), (2012).
- Alcides Chaux, Elsa F. Velazquez, Ali Amin, Ana Soskin, Rolf Pfannl, Ingrid M. Rodríguez, José E. Barreto, Cecilia Lezcano, Gustavo Ayala, George J. Netto and Antonio L. Cubilla, Distribution and characterization of subtypes of penile intraepithelial neoplasia and their association with invasive carcinomas: a pathological study of 139 lesions in 121 patients, Human Pathology, 43, 7, (1020), (2012).
- Milan Bjekić, Milica Markovic and Sandra Šipetić, CLINICAL, DEMOGRAPHIC AND LIFESTYLE CHARACTERISTICS OF MEN WITH GENITAL LICHEN SCLEROSUS, acta medica medianae, (24), (2012).
- E.V.J. Edmonds, S. Hunt, D. Hawkins, M. Dinneen, N. Francis and C.B. Bunker, Clinical parameters in male genital lichen sclerosus: a case series of 329 patients, Journal of the European Academy of Dermatology and Venereology, 26, 6, (730-737), (2011).
- M. Gutiérrez-Pascual, F.J. Vicente-Martín and J.L. López-Estebaranz, Lichen Sclerosus and Squamous Cell Carcinoma, Actas Dermo-Sifiliográficas (English Edition), 103, 1, (21), (2012).
- Milan Bjekić, Milica Markovic and Sandra Šipetić, KLINIČKE I DEMOGRAFSKE KARAKTERISTIKE I ODLIKE STILOVA ŽIVOTA MUŠKARACA SA GENITALNIM LICHEN SCLEROSUS-OM, Acta medica medianae, (24), (2012).
- Maaike C. G. Bleeker, Daniëlle A. M. Heideman, Peter J. F. Snijders, Simon Horenblas and Chris J. L. M. Meijer, Epidemiology and Etiology of Penile Cancer, Textbook of Penile Cancer, 10.1007/978-1-84882-879-7_1, (1-11), (2011).
- C.J.M. Henquet, Anogenital malignancies and pre‐malignancies, Journal of the European Academy of Dermatology and Venereology, 25, 8, (885-895), (2011).
- Neil H. Cox and John S. C. English, Inflammatory Dermatoses, British Association of Dermatologists' Management Guidelines, (1-90), (2011).
- , Lichen Planus and Related Conditions, Andrews' Diseases of the Skin, 10.1016/B978-1-4377-0314-6.00012-7, (213-227), (2011).
- Enzo Palminteri, Fernando Fusco, Elisa Berdondini and Andrea Salonia, Aesthetic neo-glans reconstruction after penis-sparing surgery for benign, premalignant or malignant penile lesions, Arab Journal of Urology, 9, 2, (115), (2011).
- David Clouston, Anthony Hall and Nathan Lawrentschuk, Penile lichen sclerosus (balanitis xerotica obliterans), BJU International, 108, s2, (14-19), (2011).
- P. Bigot, Le point sur les lésions dermatologiques du pénis : comment repérer les lésions précancéreuses du pénis ?, Progrès en Urologie, 10.1016/S1166-7087(11)70011-2, 21, (S50-S52), (2011).
- C. Hofer, F.-M. Köhn, G.S. Hatzichristodoulou, J.E. Gschwend and U. Treiber, Lichen sclerosus im Urogenitalbereich, Der Urologe, 50, 10, (1291), (2011).
- Judith Oertell, Carmelo Caballero, Manuelita Iglesias, Alcides Chaux, Luís Amat, Enrique Ayala, Ingrid Rodríguez, Elsa F Velázquez, José E Barreto, Gustavo Ayala and Antonio L Cubilla, 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, 58, 6, (925-933), (2011).
- Brian J. Morris, Ronald H. Gray, Xavier Castellsague, F. Xavier Bosch, Daniel T. Halperin, Jake H. Waskett and Catherine A. Hankins, The Strong Protective Effect of Circumcision against Cancer of the Penis, Advances in Urology, 2011, (1), (2011).
- Fabiana Braga França Wanick, Tullia Cuzzi Teichner, Rosane Silva, Mônica Maria Ferreira Magnanini and Lucia Maria Soares de Azevedo, Carcinoma epidermoide do pênis: estudo clínico-patológico de 34 casos, Anais Brasileiros de Dermatologia, 86, 6, (1082), (2011).
- Alcides Chaux, Cecilia Lezcano, Antonio L. Cubilla, Pheroze Tamboli, Jae Ro and Alberto Ayala, Comparison of Subtypes of Penile Squamous Cell Carcinoma From High and Low Incidence Geographical Regions, International Journal of Surgical Pathology, 18, 4, (268), (2010).
- C. Renaud-Vilmer and B. Cavelier-Balloy, Les lésions précancéreuses du pénis, Annales de Dermatologie et de Vénéréologie, 10.1016/j.annder.2010.05.001, 137, 6-7, (486-492), (2010).
- David Weedon, The granulomatous reaction pattern, Weedon's Skin Pathology, 10.1016/B978-0-7020-3485-5.00008-5, (169-194.e17), (2010).
- S.M. Neill, F.M. Lewis, F.M. Tatnall and N.H. Cox, British Association of Dermatologists’ guidelines for the management of lichen sclerosus 2010, British Journal of Dermatology, 163, 4, (672-682), (2010).
- S‐H Wang, C‐C Chi, YW Wong, A Salim, S Manek and F Wojnarowska, Genital verrucous carcinoma is associated with lichen sclerosus: a retrospective study and review of the literature, Journal of the European Academy of Dermatology and Venereology, 24, 7, (815-819), (2009).
- Catherine Renaud-Vilmer, Benedicte Cavelier-Balloy, Olivier Verola, Patrice Morel, Jean Marie Servant, François Desgrandchamps and Louis Dubertret, Analysis of alterations adjacent to invasive squamous cell carcinoma of the penis and their relationship with associated carcinoma, Journal of the American Academy of Dermatology, 62, 2, (284), (2010).
- Suks Minhas, Andreas Manseck, Stephen Watya and Paul K. Hegarty, Penile Cancer—Prevention and Premalignant Conditions, Urology, 10.1016/j.urology.2010.04.007, 76, 2, (S24-S35), (2010).
- David Weedon, Disorders of collagen, Weedon's Skin Pathology, 10.1016/B978-0-7020-3485-5.00012-7, (303-329.e27), (2010).
- Paul L. Crispen and Jack H. Mydlo, Penile Intraepithelial Neoplasia and Other Premalignant Lesions of the Penis, Urologic Clinics of North America, 10.1016/j.ucl.2010.04.003, 37, 3, (335-342), (2010).
- C. B. Bunker and S. M. Neill, The Genital, Perianal and Umbilical Regions, Rook's Textbook of Dermatology, (1-102), (2010).
- PHEROZE TAMBOLI, ANTONIO L. CUBILLA and MAHUL B. AMIN, Penis and Scrotum, Modern Surgical Pathology, 10.1016/B978-1-4160-3966-2.00033-3, (1181-1196), (2009).
- Matthew J. Wasco and Rajal B. Shah, Benign Diseases and Neoplasms of the Penis, Surgical Pathology Clinics, 2, 1, (161), (2009).
- M. C. G. Bleeker, D. A. M. Heideman, P. J. F. Snijders, S. Horenblas, J. Dillner and C. J. L. M. Meijer, Penile cancer: epidemiology, pathogenesis and prevention, World Journal of Urology, 10.1007/s00345-008-0302-z, 27, 2, (141-150), (2008).
- D.M. Prowse, E.N. Ktori, D. Chandrasekaran, A. Prapa and S. Baithun, Human papillomavirus‐associated increase in p16INK4A expression in penile lichen sclerosus and squamous cell carcinoma, British Journal of Dermatology, 158, 2, (261-265), (2007).
- W‐Y. Au, C‐K. Yeung, M‐C. Cheung and N.J. Trendell‐Smith, Penile lichen sclerosus after allogeneic stem cell transplantation, British Journal of Dermatology, 159, 2, (470-472), (2008).
- S Gupta and A B MacLean, Vulval complaints in postmenopausal women, Aging Health, 4, 5, (543), (2008).
- Jae Y. Ro, Kyu-Rae Kim, Mahul B. Amin and Alberto G. Ayala, Penis and scrotum, Urologic Surgical Pathology, 10.1016/B978-0-323-01970-5.50017-8, (890-950), (2008).
- Vishal Bhalani, Tobias S. Köhler and Robert E. Brannigan, Common penile dermatoses, Current Sexual Health Reports, 5, 3, (124), (2008).
- Nitin Ranjan and Satyendra Kumar Singh, Malignant transformation of penile lichen sclerosus: exactly how common is it?, International Journal of Dermatology, 47, 12, (1308-1309), (2008).
- Marcos A. Scheiner, Mercia M. Campos, Antonio A. Ornellas, Eduardo W. Chin, Maria H. Ornellas and Maria J. Andrada-Serpa, Human papillomavirus and penile cancers in Rio de Janeiro, Brazil: HPV typing and clinical features, International braz j urol, 34, 4, (467), (2008).
- C. B. Bunker and S. M. Neill, The Genital, Perianal and Umbilical Regions, Rook's Textbook of Dermatology, (3535-3638), (2008).
- Jennifer M. Pugliese, Allen F. Morey and Andrew C. Peterson, Lichen Sclerosus: Review of the Literature and Current Recommendations for Management, The Journal of Urology, 178, 6, (2268), (2007).
- Robert S. Van Howe, Human papillomavirus and circumcision: A meta-analysis, Journal of Infection, 54, 5, (490), (2007).
- Enzo Palminteri, Elisa Berdondini, Massimo Lazzeri, Francesco Mirri and Guido Barbagli, Resurfacing and Reconstruction of the Glans Penis, European Urology, 52, 3, (893), (2007).
- Maria Rita Nasca, Daniele Innocenzi and Giuseppe Micali, Association of penile lichen sclerosus and oncogenic human papillomavirus infection, International Journal of Dermatology, 45, 6, (681-683), (2005).
- T. Windahl, Is carbon dioxide laser treatment of lichen sclerosus effective in the long run?, Scandinavian Journal of Urology and Nephrology, 40, 3, (208), (2006).
- G. Barbagli, E. Palminteri, F. Mirri, G. Guazzoni, D. Turini and M. Lazzeri, Penile Carcinoma in Patients With Genital Lichen Sclerosus: A Multicenter Survey, The Journal of Urology, 175, 4, (1359), (2006).
- PETER PIETRZAK, PAUL HADWAY, CATHY M. CORBISHLEY and NICHOLAS A. WATKIN, Is the association between balanitis xerotica obliterans and penile carcinoma underestimated?, BJU International, 98, 1, (74-76), (2006).
- Giuseppe Micali, Maria R. Nasca, Daniele Innocenzi and Robert A. Schwartz, Penile cancer, Journal of the American Academy of Dermatology, 10.1016/j.jaad.2005.05.007, 54, 3, (369-391), (2006).
- András Kiss, László Király, Balázs Kutasy and Miklós Merksz, High Incidence of Balanitis Xerotica Obliterans in Boys with Phimosis: Prospective 10‐Year Study, Pediatric Dermatology, 22, 4, (305-308), (2005).
- Elsa F. Velazquez and Antonio L. Cubilla, Pseudohyperplastic Squamous Cell Carcinoma of the Penis Associated With Lichen Sclerosus, Pathology Case Reviews, 10, 1, (21), (2005).
- John P Arlette and Martin J Trotter, Squamous cell carcinoma in situ of the skin: History, presentation, biology and treatment, Australasian Journal of Dermatology, 45, 1, (1-11), (2004).
- Stuart Enoch, David R Miller, Patricia E Price and Keith G Harding, 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, International Wound Journal, 1, 3, (165-175), (2004).
- Giuseppe Micali, Maria R. Nasca, Daniele Innocenzi and Robert A. Schwartz, Invasive Penile Carcinoma: A Review, Dermatologic Surgery, 30, (311-320), (2004).
- P. Ena, P. Lorrai, A. Pintus, V. Marras and L. A. Dessy, Development of multifocal squamous cell carcinoma in lichen sclerosus et atrophicus of the penis associated to HCV hepatitis, Andrologia, 36, 1, (38-40), (2004).
- Andrew C. Peterson and George D. Webster, Management of urethral stricture disease: developing options for surgical intervention, BJU International, 94, 7, (971-976), (2004).
- GIUSEPPE MICALI, MARIA R. NASCA, DANIELE INNOCENZI and ROBERT A. SCHWARTZ, Invasive Penile Carcinoma, Dermatologic Surgery, 30, (311), (2004).
- Andrew C. Peterson, Enzo Palminteri, Massimo Lazzeri, Giorgio Guanzoni, Guido Barbagli and George D. Webster, Heroic measures may not always be justified in extensive urethral stricture due to lichen sclerosus (balanitis xerotica obliterans), Urology, 64, 3, (565), (2004).
- G. L. Tasker and F. Wojnarowska, Lichen sclerosus, Clinical and Experimental Dermatology, 28, 2, (128-133), (2003).
- G. Perceau, C. Derancourt, C. Clavel, A. Durlach, M. Pluot, B. Lardennois and P. Bernard, Lichen sclerosus is frequently present in penile squamous cell carcinomas but is not always associated with oncogenic human papillomavirus, British Journal of Dermatology, 148, 5, (934-938), (2003).
- G.P. Thami and S. Kaur, Genital lichen sclerosus, squamous cell carcinoma and circumcision, British Journal of Dermatology, 148, 5, (1083-1084), (2003).
- MR Nasca, C Panetta, G Micali and D Innocenzi, Microinvasive squamous cell carcinoma arising on lichen sclerosus of the penis, Journal of the European Academy of Dermatology and Venereology, 17, 3, (337-339), (2003).
- Elsa F. Velazquez and Antonio L. Cubilla, Lichen Sclerosus in 68 Patients With Squamous Cell Carcinoma of the Penis, The American Journal of Surgical Pathology, 27, 11, (1448), (2003).
- Ricardo F Sánchez-Ortiz and Curtis A Pettaway, Natural history, management, and surveillance of recurrent squamous cell penile carcinoma:, Urologic Clinics of North America, 30, 4, (853), (2003).
- J.P. Arlette, Treatment of Bowen's disease and erythroplasia of Queyrat, British Journal of Dermatology, 149, (43-47), (2003).
- Aurora Guerra, Liquen escleroso, Actas Dermo-Sifiliográficas, 94, 10, (633), (2003).
- S. Kaur, G. P. Thami, A. J. Kanwar and H. Mohan, Linear oro‐facial lichen sclerosus, Clinical and Experimental Dermatology, 27, 6, (467-470), (2002).
- S.M. Neill, F.M. Tatnall and N.H. Cox, Guidelines for the management of lichen sclerosus, British Journal of Dermatology, 147, 4, (640-649), (2002).
- S.A. Buechner, Common skin disorders of the penis, BJU International, 90, 5, (498-506), (2002).
- S Wakelin, MYCOPHENOLATE MOFETIL, Systemic Drug Treatment in Dermatology, 10.1201/b16367-22, (182-186), (2014).
- Andreas Recke, C. Hallermann and C. Neumann, Perianale Ulzera bei einem Kind, Der Hautarzt, 53, 10, (686), (2002).
- Olivia A. Charlton and Saxon D. Smith, Balanitis xerotica obliterans: a review of diagnosis and management, International Journal of Dermatology, , (2018).




