Development of male genital lichen sclerosus in penile reconstruction skin grafts after cancer surgery: an unreported complication

Abstract

What ' s known on the subject? and What does the study add? Male genital lichen sclerosis is a disease of unknown aetiology which is believed to be a risk factor for penile cancer.This study reports that the disease can develop in non-genital skin grafts used for reconstruction following penile cancer surgery. OBJECTIVE• To describe the incidence of the development of male genital lichen sclerosus (LS) in non-genital skin grafts used in penile reconstruction after cancer surgery. PATIENTS AND METHODS• Between 1997 and 2009, 177 patients received surgical treatment for penile cancer in the Urology Department at Sunderland Royal Hospital, the regional penile cancer centre for the north-east of England.• Patients who had organ-sparing surgery and non-genital penile graft reconstructions were identifi ed.• Histology reports for specimens obtained from those grafts were reviewed to identify the presence of male genital LS and the incidence of recurrence of squamous cell carcinoma (SCC). RESULTS• The mean (range) age of patients at diagnosis was 61.8 (32 -89) years. Of the 177 patients, 139 had SCC, 32 had carcinoma in situ and six had verrucous carcinoma.• In total, 56 penile reconstructive procedures were performed using split-thickness skin grafts obtained from the inner thigh.• From those grafts, 18 specimens were obtained later for cosmetic, diagnostic or curative purposes.• Male genital LS was found in six of the 18 specimens, and one of them was associated with recurrent verrucous carcinoma. CONCLUSIONS• This is the fi rst published series to describe the incidence of male genital LS in penile skin grafts taken from a remote site after penile cancer surgery.• These results represent new information that might help explain the aetiology of male genital LS. KEYWORDS

Genital lichen sclerosus/balanitis xerotica obliterans in men with penile carcinoma: a critical analysis

“…The phenomenon of LS/BXO involving extragenital skin grafts used for genital reconstruction has been reported previously . Recently, Abdelbaky et al.…”

“…Recently, Abdelbaky et al. reported their experience in a series of 56 patients who were managed by organ‐sparing surgery and SSG reconstruction. In 18 (32.1%) patients, a graft biopsy was performed during follow‐up (mean of 42.7 months) for cosmetic or diagnostic reasons.…”

Occlusion, urine and genital lichen sclerosus

“…However, MGLSc occurs and recurs in grafts. [4,7] Arguably, the arrangement of the distal urethra, navicular fossa and meatus has evolved to function as a low-pressure valve. The embryology is complicated and a wide, albeit often subtle, variation in naviculomeatal valve structure and function, and the relationships of both to striking variation in the structure and function of the prepuce, is revealed by meticulous clinical assessment.…”

Current views on the diagnosis and treatment of genital lichen sclerosus

“…Najnowsze badania kładą jednak nacisk na wpływ innych czynników związanych ze wzrostem ryzyka zachorowania na LS [16][17][18]. Część autorów uważa, że miejscowy uraz i zaleganie moczu są ważnymi czynnikami wybitnie zwiększającymi możliwość wystąpienia LS [12,[19][20][21]. Inne stany również wpływa-ją na zwiększenie ryzyka zapadalności na LS.…”