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International Journal of STD & AIDS Feb 2006Squamous cell carcinoma of the penis is an uncommon cancer, though in one study it accounted for 90% of all penile cancers. Its association with balanitis xerotica...
Squamous cell carcinoma of the penis is an uncommon cancer, though in one study it accounted for 90% of all penile cancers. Its association with balanitis xerotica obliterans (BXO) is a rare though recognized occurrence. We describe a case of a 46-year-old Caucasian male who first presented to our open-access clinic with a mild phimosis. An elective circumcision was performed and histological examination of the circumcision specimen showed BXO. He was lost to follow-up but re-presented three years later with a persistent tender penile ulcer which on biopsy showed no obvious sinister pathology. He returned a further two years later with a short history of bleeding from the ulcer, and another biopsy now confirmed penile squamous cell carcinoma. Our case emphasizes the importance of regular review of patients with BXO, in particular those with persistent symptoms.
Topics: Balanitis; Carcinoma, Squamous Cell; Humans; Male; Middle Aged; Penile Neoplasms; Penis
PubMed: 16464280
DOI: 10.1258/095646206775455658 -
The Urologic Clinics of North America Feb 1992Premalignant lesions of the penis include cutaneous horn, balanitis xerotica obliterans, and leukoplakia. The true incidence of progression of each of these to... (Review)
Review
Premalignant lesions of the penis include cutaneous horn, balanitis xerotica obliterans, and leukoplakia. The true incidence of progression of each of these to squamous-cell carcinoma is unknown. Bowenoid papulosis, erythroplasia of Queyrat, and Bowen's disease are histologically identical to in situ carcinoma. Although the first is consistently benign, the latter two regularly evolve into invasive cancer. Malignant scrotal lesions include squamous-cell carcinoma, liposarcoma, leiomyosarcoma, basal-cell carcinoma, extramammary Paget's disease, erythroplasia of Queyrat, malignant melanoma, and metastases. Hemangioma can be confused with carcinoma.
Topics: Carcinoma; Carcinoma, Squamous Cell; Genital Neoplasms, Male; Humans; Male; Penile Neoplasms; Precancerous Conditions; Scrotum
PubMed: 1736473
DOI: No ID Found -
Journal of the American Academy of... Aug 2012Lichen sclerosus (LS) is a chronic inflammatory dermatosis that occurs mainly in the anogenital area and causes itching and soreness. Progressive destructive scarring... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Lichen sclerosus (LS) is a chronic inflammatory dermatosis that occurs mainly in the anogenital area and causes itching and soreness. Progressive destructive scarring may result in burying of the clitoris in females and phimosis in males. Affected people have an increased risk of genital cancers.
OBJECTIVE
We sought to assess the effects of topical interventions for genital LS.
METHODS
We undertook a systematic review and meta-analysis using the methodology of the Cochrane Collaboration.
RESULTS
We included 7 randomized controlled trials with a total of 249 participants covering 6 treatments. Clobetasol propionate 0.05% was better than placebo in treating genital LS (participant-rated improvement/remission of symptoms: risk ratio 2.85 [95% confidence interval {CI} 1.45-5.61]; investigator-rated global degree of improvement: standardized mean difference [SMD] 5.74 [95% CI 4.26-7.23]) as was mometasone furoate 0.05% (change in clinical grade of phimosis: SMD -1.04 [95% CI -1.77 to -0.31]). We found no evidence supporting the efficacy of topical androgens and progesterone. There were no differences between pimecrolimus and clobetasol propionate in relieving symptoms through change in pruritus (SMD -0.33 [95% CI -0.99 to 0.33]) and burning/pain (SMD 0.03 [95% CI -0.62 to 0.69]). However, pimecrolimus was less effective than clobetasol propionate in improving gross appearance (investigator-rated global degree of improvement: SMD -1.64 [95% CI -2.40 to -0.87]).
LIMITATIONS
Most of the included studies were small.
CONCLUSIONS
The current limited evidence supports the efficacy of clobetasol propionate, mometasone furoate, and pimecrolimus in treating genital LS. Further randomized controlled trials are needed.
Topics: Administration, Topical; Anti-Inflammatory Agents; Balanitis Xerotica Obliterans; Female; Humans; Immunosuppressive Agents; Lichen Sclerosus et Atrophicus; Male; Randomized Controlled Trials as Topic; Vulvar Lichen Sclerosus
PubMed: 22483994
DOI: 10.1016/j.jaad.2012.02.044 -
The Urologic Clinics of North America May 2002The ability to achieve a long-term, stable, stricture-free, hairless urethral lumen in patients with complex anterior stricture and compromised genital skin is one of... (Review)
Review
The ability to achieve a long-term, stable, stricture-free, hairless urethral lumen in patients with complex anterior stricture and compromised genital skin is one of the ongoing challenges of reconstructive urologic surgery. The conservative approach by endoscopic urethrotomy or dilatation with a self-catheterization schedule rarely affects a definitive cure except in the short filmy superficial strictures of the bulbous portion of the urethra. Genital fasciocutaneous island flaps are currently the golden standard for definitive, reliable resolution of anterior urethral strictures in patients who have not undergone a prior surgical procedure that may alter the penile or scrotal circulation, or those with skin loss from trauma, decubiti, radiation, or balanitis xerotica obliterans.
Topics: Female; Humans; Male; Plastic Surgery Procedures; Surgical Flaps; Urethral Stricture; Urologic Surgical Procedures, Male
PubMed: 12371235
DOI: 10.1016/s0094-0143(02)00032-0 -
British Journal of Urology Aug 1978
Topics: Bleomycin; Humans; Leukoplakia; Male; Middle Aged; Penile Neoplasms
PubMed: 88981
DOI: 10.1111/j.1464-410x.1978.tb03650.x -
The Journal of Dermatologic Surgery and... Dec 1980Leukoplakia penis and balanitis xerotica obliterans are precancerous lesions. Bowen's disease, erythroplasia (Queyrat), and extramammary Paget's disease are carcinomas... (Review)
Review
Leukoplakia penis and balanitis xerotica obliterans are precancerous lesions. Bowen's disease, erythroplasia (Queyrat), and extramammary Paget's disease are carcinomas in situ. Lesions of both types may closely mimic benign skin conditions that may occur in the genital region. Histologic examination is usually the only certain means of diagnosis. The same considerations apply to pseudomalignancies, e.g., giant condyloma acuminatum (Buschke-Loewenstein), which clinically behaves as a carcinoma but histologically appears benign, and Bowenoid papulosis, a new entity that is believed to be benign although it has histologic features of a carcinoma in situ.
Topics: Balanitis; Bowen's Disease; Carcinoma in Situ; Carcinoma, Squamous Cell; Condylomata Acuminata; Diagnosis, Differential; Erythroplasia; Genital Neoplasms, Male; Humans; Leukoplakia; Male; Paget Disease, Extramammary; Penile Neoplasms; Skin Neoplasms
PubMed: 6259230
DOI: 10.1111/j.1524-4725.1980.tb01026.x -
The Journal of Urology Dec 2007We reviewed the literature regarding the clinical presentation, etiology, natural history, and medical and surgical management of lichen sclerosus in men. (Review)
Review
PURPOSE
We reviewed the literature regarding the clinical presentation, etiology, natural history, and medical and surgical management of lichen sclerosus in men.
MATERIALS AND METHODS
We performed a comprehensive search of the literature in PubMed, MEDLINE and other electronic databases between 1950 and 2006 using the key words lichen sclerosis, balanitis xerotica obliterans and urethral stricture. Our search resulted in 1,268 sources containing the words lichen sclerosus or balanitis xerotica obliterans. We reviewed 68 articles in the peer reviewed journals and 2 chapters on this subject.
RESULTS
Lichen sclerosus is a chronic, lymphocyte mediated skin disease that was first described in 1887. It shows a predilection for the anogenital area in men and women. Much has been discovered regarding the epidemiology, natural history and histological features of this disease process during the last century, including the discovery of a strong association between lichen sclerosus and squamous cell carcinoma. The techniques of medical and surgical management of this disorder are still being elucidated. Biopsy of the initial lesion for definitive diagnosis and long-term followup of affected patients are well established, critical elements in the management of lichen sclerosus.
CONCLUSIONS
Lichen sclerosus is a chronic, debilitating condition that may progress to cause significant voiding complications. Biopsy is recommended in all patients suspected of having lichen sclerosus to rule out squamous cell carcinoma. Further research is needed to improve the prevention, understanding and treatment of this challenging condition.
Topics: Balanitis; Cryotherapy; Female; Humans; Incidence; Laser Therapy; Lichen Sclerosus et Atrophicus; Male; Precancerous Conditions; Prognosis; Risk Assessment; Sex Distribution; Treatment Outcome; Urethral Stricture; Urologic Surgical Procedures; Vulvar Lichen Sclerosus
PubMed: 17936829
DOI: 10.1016/j.juro.2007.08.024 -
Archives of Dermatology and Syphilology Mar 1948
Topics: Balanitis; Balanitis Xerotica Obliterans; Humans; Lichen Sclerosus et Atrophicus; Male
PubMed: 18098689
DOI: No ID Found -
Archives of Dermatology and Syphilology Sep 1947
Topics: Balanitis Xerotica Obliterans; Humans; Lichen Sclerosus et Atrophicus; Male; Penile Diseases; Penis
PubMed: 20262884
DOI: No ID Found -
The Journal of Urology Dec 2020We evaluated the success of minimally invasive management of lichen sclerosus with topical and intraurethral clobetasol, as defined by improvement in patient reported...
PURPOSE
We evaluated the success of minimally invasive management of lichen sclerosus with topical and intraurethral clobetasol, as defined by improvement in patient reported outcome measures and nonprogression to surgery.
MATERIALS AND METHODS
We conducted a review of our prospective ongoing quality improvement study to determine outcomes of our current standard practice for males with penile and urethral biopsy proven lichen sclerosus. Data were collected between 2011 and 2019, and included patient demographic information, medical and surgical histories, and location and extent of lichen sclerosus related pathology. The primary outcomes for this study were voiding function and voiding related quality of life, and were assessed using the AUASS (American Urological Association Symptom Score) and quality of life bother index, respectively.
RESULTS
We identified 42 patients with biopsy proven lichen sclerosus related urethral stricture disease. Of these patients 85.7% were treated with intraurethral steroids alone and did not require surgical intervention. Median AUASS significantly improved from 12 to 8, and median quality of life bother index improved from 4 ("mostly dissatisfied") to 2 ("mostly satisfied"). Average stricture length of those with penile urethral disease and bulbar urethral disease was 4.8 cm (SD 3.0) and 16.2 cm (SD 6.5), respectively. Median followup was 8.4 months (IQR 2.6-26.4).
CONCLUSIONS
Lichen sclerosus related urethral stricture disease can be effectively managed with intraurethral steroids. This minimally invasive management strategy improves patient reported voiding symptoms and voiding quality of life.
Topics: Administration, Topical; Adult; Biopsy; Clobetasol; Follow-Up Studies; Humans; Lichen Sclerosus et Atrophicus; Male; Middle Aged; Patient Reported Outcome Measures; Patient Satisfaction; Penis; Prospective Studies; Quality of Life; Retrospective Studies; Skin Cream; Treatment Outcome; Urethra; Urethral Stricture; Urination
PubMed: 32717158
DOI: 10.1097/JU.0000000000001304