Lichen sclerosus in clinically relevant phimosis: incidence, risk factors, and association with squamous cell carcinoma of the penis

Abstract

Lichen sclerosus et atrophicus (LSA) is achronic inflammatory skin disease. It is frequently diagnosed following circumcision. Diabetes mellitus (DM) is aknown risk factor in men. Malignant pathology is more common in patients with LSA. Data on LSA in men are very limited. This study investigated the incidence of LSA in men who had undergone circumcision. Risk factors and likelihood of malignancy were captured. Data of 215 patients were retrospectively analyzed. As potential risk factors, age, body mass index (BMI), DM, coronary heart disease (CHD) and arterial hypertension were identified. Data were analyzed and displayed graphically as spike histograms. Logistic regression was applied. Age and BMI were transformed using cubic spline function. Mean age of patients was 37years (± 22years). Mean BMI was 26.4. In all, 24% of the patients had aBMI > 30. Of the patients, 11% had DM, 5.1% had CHD, and 19% had arterial hypertension. Pathology revealed LSA in 47% of patients. Malignant disease was apparent in 3.3% of patients (2.7% without concomitant LSA, 4% with concomitant LSA). Age (55vs 20years, odds ratio [OR]: 3.210 [1.421, 7.251]) was asignificant risk factor for LSA. BMI (30vs 22 kg/m2, OR 1.059 [0.614, 1.828]) and DM (OR: 0.42 [0.148, 1.192]) elevated the risk for LSA. We saw high rates of LSA in patients had undergone circumcision. Higher age represents asignificant risk factor. In 3.3%, final pathology revealed squamous cell carcinoma of the penis. Therefore, pathologic work-up of circumcision specimen is mandatory.