Genital lichen sclerosus/balanitis xerotica obliterans in men with penile carcinoma: a critical analysis. (29th January 2013)

• Record Type: Journal Article
• Authors: Philippou, Prodromos; Shabbir, Majid; Ralph, David J.; Malone, Peter; Nigam, Raj; Freeman, Alex; Muneer, Asif; Minhas, Suks
• Is Part Of: BJU international. Volume 111:Number 6(2013:Mar.)
• Page Start: 970
• Page End: 976
• Publication Date: 2013-01-29
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/j.1464-410X.2012.11773.x
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju11773-sec-1001" sec-type="section"> <title>What's known on the subject? and What does the study add?</title> <p> <list id="bju11773-list-0001" list-type="bullet"> <list-item> <p>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.</p> </list-item> <list-item> <p>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.</p> </list-item> </list> </p> </sec> <sec id="bju11773-sec-2001" sec-type="section"> <title>Objectives</title> <p> <list id="bju11773-list-0002" list-type="bullet"> <list-item> <p>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.</p> </list-item> <list-item> <p>To report the phenomenon of LS involving non‐genital skin grafts in patients who underwent organ‐sparing surgery and split‐skin graft (SSG) reconstruction</p> </list-item> </list> </p> </sec> <sec id="bju11773-sec-1002" sec-type="section"> <title>Patients and Methods</title> <p> <list id="bju11773-list-0003" list-type="bullet"> <list-item> <p>Between January 2002 and January 2010, 223 men underwent surgical treatment for pSCC.</p> </list-item> <list-item> <p>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; <italic>n</italic> = 171; 76.7%).</p> </list-item> <list-item> <p>A subgroup of patients who underwent surgical excision and SSG reconstruction was also identified</p> </list-item> <list-item> <p>The histology reports of graft biopsies obtained during follow‐up were reviewed and the rate of LS involving the graft was also recorded.</p> </list-item> </list> </p> </sec> <sec id="bju11773-sec-1003" sec-type="section"> <title>Results</title> <p> <list id="bju11773-list-0004" list-type="bullet"> <list-item> <p>Mean (range) age at diagnosis was 60.9 (34–81) years and 60.7 (28–89) years for groups A and B, respectively (<italic>P</italic> = 0.958).</p> </list-item> <list-item> <p>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 (<italic>P</italic> = 0.162)</p> </list-item> <list-item> <p>No statistically significant differences were noted between groups A and B in terms of tumour grade (<italic>P</italic> = 0.091), stage (<italic>P</italic> = 0.697), presence of lymphovascular invasion (<italic>P</italic> = 0.333), histological subtype (<italic>P</italic> = 0.107), associated carcinoma <italic>in situ</italic> (<italic>P</italic> = 0.246) or nodal status at initial diagnosis (<italic>P</italic> = 0.555).</p> </list-item> <list-item> <p>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.</p> </list-item> <list-item> <p>Genital LS involving the graft was identified in seven specimens, although none of these seven cases had associated recurrent pSCC.</p> </list-item> </list> </p> </sec> <sec id="bju11773-sec-1004" sec-type="section"> <title>Conclusions</title> <p> <list id="bju11773-list-0005" list-type="bullet"> <list-item> <p>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 <italic>in situ</italic>.</p> </list-item> <list-item> <p>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.</p> </list-item> </list> </p> </sec> </abstract>