Lichen Sclerosus et Atrophicus: Findings after Complete Circumcision

Abstract

We prospectively evaluated 75 patients, 30-77 years old, with severe phimosis. All patients were treated surgically by complete circumcision and all surgical specimens were sent for histological evaluation. All patients with histologically proven lichen sclerosus et atrophicus (LSA) (eight patients, 10.6%) were re-evaluated 6 months postoperatively, and all but one were examined 5 years after the operation. All patients with histologically proven balanoposthitis (BP) (47 patients, 62.6%) were also re-evaluated 6 months postoperatively, and 41 patients 5 years after surgery. This group (BP) was the control group of our study. Six months after the operation, the eight patients with histologically proven LSA all had an excellent convalescence, and the lesions observed during the operation resolved in four patients and regressed in two patients. In one patient the glans presented with a pale grey-white-coloured plaque. Biopsy was performed and a well-differentiated squamous cell carcinoma infiltrating the glans was revealed. The control group of patients with histologically proven BP were also re-evaluated 6 months and 5 years after surgery. An excellent convalescence was observed in all patients who completed the follow-up examination. Care must be taken not to underestimate the potential relationship between LSA and squamous cell carcinoma, because the latter is usually invasive, very aggressive and requires immediate treatment.

Histopathological examination of the prepuce after circumcision: Is it a waste of resources?

“…The histopathological spectrum of BXO varies according to different classification, from early atypical changes to the typical fibrosing type. [7,8] However, any change within this spectrum has to be considered significant as it represents a precursor lesion that might develop to a full process. Without histopathology of circumcised foreskin, five of eight patients (62%) with BXO would have been missed in our study.…”

“…The small sample size of this study (52 patients) may limit the value for defining the real incidence of this disease but this incidence is in consistence with the reported incidence of 10-40% in different studies. [2,4,7] Clinical features of BXO can range from mild to florid and extensive disease. Clinically, an established case of BXO can be detected easily; however, the early features of BXO in children are subtle and could be missed.…”

“…Severe typhoid fever with enteric involvement perforates leading to serious surgical complications with high morbidity and mortality. [4][5][6][7] Peritonitis follows typhoid enteric perforation. [8] Management of typhoid enteric perforation is surgically challenging.…”

Histopathological evaluation of the preputium in preschool and primary school boys

“…It is synonymous with lichen sclerosus et atrophicus (LSA) which is an inflammatory skin disease of unknown aetiology that mainly affects the genital area and results in phimosis in male and vulvar keratosis in female [4][5][6][7][8]. It can be a precursor lesion for the squamous cell carcinoma [9,10]. The affected population ranges from 6 months of age to late adulthood [4][5][6][7][8][9][10].…”

“…The affected population ranges from 6 months of age to late adulthood [4][5][6][7][8][9][10]. The incidence of classic LSA in patients with phimosis is variable in the literature ( [5,7,8,10,11,12]. The rate is higher in patients with secondary phimosis (Mattioli et al 60%) [8].…”