An overview of benign and premalignant lesions of the foreskin

Abstract

The foreskin is a common surgical specimen encountered by the practising histopathologist. Therapeutic circumcisions are performed to treat both benign and neoplastic foreskin lesions. Penile intraepithelial neoplasia (PeIN) is the precursor lesion of penile squamous cell carcinoma (SCC). The World Health Organisation (WHO) classifies PeIN into two subtypes based on the association with Human Papillomavirus (HPV); these include differentiated and undifferentiated PeIN. These subtypes of PeIN can be differentiated by specific cytological and architectural characteristics. This review article will discuss these histological characteristics and highlight potential difficulties that may arise in diagnosing PeIN. Furthermore, it will also consider common benign and preneoplastic foreskin lesions that may be encountered when reporting the foreskin specimen.

Penile cancer: HPV, lichen sclerosis and circumcision

“…Penile precursor lesions (PeIN) are also classified according to their association with HPV, with undifferentiated PeIN (which account for 25% of all penile precursor lesions) associated with hr‐HPV 13 . Undifferentiated PeIN are usually flat erythematous lesions found on the penile glans and/or foreskin 11 .…”

“…11,12 Penile precursor lesions (PeIN) are also classified according to their association with HPV, with undifferentiated PeIN (which account for 25% of all penile precursor lesions) associated with hr-HPV. 13 Undifferentiated PeIN are usually flat erythematous lesions found on the penile glans and/or foreskin. 11 Various treatment options for PeIN are recognised in current guidelines that include radical circumcision with topical chemotherapy, laser treatment or surgical excision with skin grafting.…”