Is the association between balanitis xerotica obliterans and penile carcinoma underestimated?

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.

Analysis of alterations adjacent to invasive squamous cell carcinoma of the penis and their relationship with associated carcinoma

“…In the literature, this association has been reported in 9.3% to 50% of cases. 2,17,[26][27][28][29][30] The variability of these rates could be explained by the difficulty to recognize the histologic features of LS because areas of hyalinized collagen can be scant and discontinuous. Orcein staining can help to identify the absence of elastic fibers in the dermal fibrosis.…”

Foreskin preputioplasty and intralesional triamcinolone: a valid alternative to circumcision for balanitis xerotica obliterans

“…Balanitis xerotica obliterans (also described as lichen sclerosus et atrophicus) has been associated with squamous cell carcinoma in the adult literature [9,10]; however, there is no such evidence within the pediatric population. A recent review and international consensus statement found that the evidence base for the association of BXO and malignancy is not robust and is unable to provide any treatment recommendations [10].…”

Fossa Navicularis and Meatal Reconstruction

“…The differential diagnosis includes erythroplasia of Queyrat, leukoplakia, scleroderma, and cicatricial pemphigoid. A causal relationship between LS and squamous cell carcinoma has been suggested but not substantiated [ 10 ].…”