Male genital lichen sclerosus in recipients of bone marrow transplants

Abstract

We describe two patients who received haematopoietic stem cell marrow transplantation, and developed male genital lichen sclerosus (MGLSc), one of whom also had squamous carcinoma in situ (Bowen disease). MGLSc has previously been associated with graft-versus-host disease. Various aetiological factors for LSc have been proposed, including a role for chronic occluded epithelial exposure to urine. A number of factors imply that the risk of malignant transformation in this bone marrow transplant group is likely to be higher than the overall figure of 2-9% cited for MGLSc. It is vital, therefore, that clinicians involved in the care of those with haematological malignancies are adequately prepared to examine the genitals of their patients, and to recognize and refer any suspect penile lesions.

Male-Specific Late Effects in Adult Hematopoietic Cell Transplantation Recipients: A Systematic Review from the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research and Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation

“…In the past 10 years, several case reports [15][16][17][18][19][20][21][22][23][24] and a few cohort studies [25][26][27][28] have specifically reported on manifestations of genital male chronic GvHD (cGvHD), often associated with systemic cGvHD. The incidence of genital cGvHD in men varies between 5% 26 and 20% 25,27 , depending upon the evaluated cohort (i.e., asymptomatic patients vs patients who seek care for symptoms).…”

“…125,140 Single cases of squamous cell carcinoma have been reported in patients with genital lichen sclerosis, likely related to cGvHD. 23 Penile carcinoma might be underestimated, since carcinogenesis in male genital lichen sclerosis in the general population can be as high as 10%. 141…”