Penile Intraepithelial Neoplasia Research Articles

WHO 2022 classification of penile and scrotal cancers: updates and evolution.

Squamous cell carcinoma (SCC) is the most common malignant tumour of the penis. The 2022 WHO classification reinforces the 2016 classification and subclassifies precursor lesions and tumours into human papillomavirus (HPV)-associated and HPV-independent types. HPV-associated penile intraepithelial neoplasia (PeIN) is a precursor lesion of invasive HPV- associated SCC, whereas differentiated PeIN is a precursor lesion of HPV-independent SCC. Block-type positivity of p16 immunohistochemistry is the most practical daily utilised method to separate HPVassociated from HPVindependent penile SCC. If this is not feasible, the term SCC, not otherwise specified (NOS) is appropriate. Certain histologies that were previously classified as"subtypes" are now grouped, and coalesced as "patterns", under the rubric of usual type SCC and verrucous carcinoma (e.g. usual-type SCC includes pseudohyperplastic and acantholytic/pseudoglandular carcinoma, and carcinoma cuniculatum is included as a pattern of verrucous carcinoma). If there is an additional component of the usual type of invasive SCC (formerly termed hybrid histology), the tumour would be a mixed carcinoma (e.g. carcinoma cuniculatum or verrucous carcinoma with usual invasive SCC); in such cases, reporting of the relative percentages in mixed tumours may be useful. The consistent use of uniform nomenclature and reporting of percentages will inform the refinement of future reporting classification schemes and guidelines/recommendations. The classification of scrotal tumours is provided for the first time in the fifth edition of the WHO Blue book, and it follows the schema of penile cancer classification for both precursor lesions and the common SCC of the scrotum. Basal cell carcinoma of the scrotum may have a variable clinical course and finds a separate mention.

P003 - Risk of local recurrence in men with Penile Intraepithelial Neoplasia (PeIN) in the surgical margin after penile sparing surgery

P003 - Risk of local recurrence in men with Penile Intraepithelial Neoplasia (PeIN) in the surgical margin after penile sparing surgery

Pathological characterization and clinical outcome of penile intraepithelial neoplasia variants: a North American series

AbstractPenile intraepithelial neoplasia (PeIN) is classified as human papillomavirus (HPV)- and non-HPV-related. This classification is associated with distinct morphologic subtypes. The natural history and prognosis of PeIN subtypes are not well known. This study aims to evaluate clinicopathological features, HPV status, and outcome of PeIN subtypes. Eighty-two lesions from 64 patients with isolated PeIN were retrospectively reviewed. Mean age was 59 years. Lesions were multicentric in 34% of patients and affected glans (33%), shaft (26%), and foreskin (20%). Histologically, 22% of patients had coexisting lesions, classified as hybrid and mixed. HPV-related PeIN (97%) included basaloid (59%), warty (8%), warty-basaloid (8%), hybrid (19%) and mixed (3%) types. P16 and HPV positivity occurred in 99% and 82% of lesions, respectively. HPV 16 was more common in basaloid PeIN. Multiple genotypes were detected in 35%, more commonly in hybrid PeIN (P = 0.051). Positive margins occurred in 63% of excisions. PeIN recurred in 48% of excisions and 30% of overall repeated procedures, and progression to invasive carcinoma occurred in 2%. At follow-up, 86% of patients had no evidence of disease and 12% were alive with disease. Lichen sclerosus occurred in non-HPV and HPV-related PeIN (100% and 47%).In conclusion, HPV-related and, more specifically basaloid PeIN were the predominant types and preferentially associated with HPV 16. While PeIN had a high recurrence rate, there was a slow and infrequent progression to invasive or metastatic carcinoma with multimodal treatments. Additional studies are needed to understand biology and natural history of PeIN.

Pseudoepitheliomatous keratotic and micaceous balanitis: a series of eight cases.

Pseudoepitheliomatous keratotic and micaceous balanitis (PEKMB) is a clinicopathological entity characterized clinically by micaceous scale on the glans, and histologically by acanthosis, hyperkeratosis and pseudoepitheliomatous hyperplasia. We present a series of eight cases of this rare condition, the first series of more than two cases to be reported. To determine the clinical and histological characteristics of cases of PEKMB, and evaluate treatments used and clinical course. This monocentric case series was conducted at the University College London Hospitals tertiary male genital dermatology clinic between April 2018 and August 2020. Eight patients with PEKMB were evaluated. Data were collected on demographics, clinical presentation, histological features, presence of human papilloma virus (HPV), history of lichen sclerosus, treatment of PEKMB and subsequent response, and presence or development of squamous cell carcinoma (SCC) or penile intraepithelial neoplasia (PeIN) during follow-up. Eight Caucasian males presented with clinical and histological evidence of PEKMB. Seven had a background of lichen sclerosus; two had failed treatment with superpotent topical steroids and four had symptoms for three or more years prior to circumcision. There was no clinical or histological relationship with HPV infection, and p16 staining was negative. HPV PCR, performed in two cases, was negative. Basal atypia, insufficient to amount to PeIN, was present in six patients. One patient progressed to PeIN during follow-up, and no patient progressed to invasive malignancy. Five patients were treated successfully with glans resurfacing and split skin graft reconstruction. Our observations demonstrate that PEKMB represents a form of chronic, undiagnosed or misdiagnosed, inadequately treated or treatment refractory, unstable lichen sclerosus. The significant potential for squamous carcinogenesis (differentiated PeIN and verrucous carcinoma) can be mitigated by timely diagnosis and treatment. Glans resurfacing and split skin graft reconstruction appears to be a successful treatment modality in patients with refractory disease.

Prevalence and sequelae of penile lichen sclerosus in males presenting for circumcision in regional Australia: a multicentre retrospective cohort study.

BackgroundLichen sclerosus (LS) in men commonly involves the external genitalia, with up to 20% of these patients developing urethral stricture disease, and a small group developing malignant transformation to penile squamous cell carcinoma (SCC). The objective of this study was to determine the prevalence of LS and its sequelae in males presenting for circumcision.MethodsA multicentre retrospective cohort study was conducted at 8 hospitals within 3 Australian regional centres. We identified males who underwent circumcision between January 2004 and November 2018 and obtained histological and clinical data. Histopathological confirmation of LS was the primary outcome. Development of urethral stricture disease and penile cancer were secondary outcomes.ResultsSix hundred and eleven patients underwent circumcision, of which 313 (51.2%) had a specimen sent for histology. Of these, 199 (63.6%) had confirmed LS where the median age at diagnosis was 65 years [interquartile range (IQR), 40–77]. Even if the remainder of unsent specimens were free of LS, the prevalence would still be 32.6%. Amongst the patients with LS, 44 (22.1%) developed urethral strictures, 1 penile SCC (0.5%), and 1 penile intraepithelial neoplasia (0.5%).ConclusionsThe prevalence of LS in patients undergoing circumcision where the foreskin was sent for histopathological review was 63.6%. In those with LS, the prevalence of urethral stricture disease was 22.1%.

HPV Vaccination: Does It Have a Role in Preventing Penile Cancer and Other Preneoplastic Lesions?

Human papillomavirus (HPV) is the most common sexually transmitted infection globally, which causes nearly all cervix carcinomas and contributes to oropharyngeal, penile, vulva, vagina, and anal cancers. Despite the role of HPV in several preneoplastic and cancerous lesions in men, male vaccine coverage is low. This article aims to provide insights into the pathophysiology of HPV-related penile cancer and penile intraepithelial neoplasia (PeIN). Moreover, this review endeavors to outline the advantages of implementing HPV vaccination in male vaccination programs and the role of health care providers in this mission. This is a narrative review of relevant literature. A search on PubMed and Cochrane database was conducted. The following search terms were used: HPV vaccination, gender-neutral vaccination, male, genital warts, penile cancer, vaccine recommendations. HPV is responsible for 50.8% of penile cancers globally, 79.8% of PeIN, and 90% of genital warts. In 2009 the Food and Drug Administration licensed the quadrivalent HPV vaccine for use in males, with a potential efficacy of 90% and 77.5% to reduce genital warts and anal intraepithelial neoplasia, respectively. However, the uptake of HPV vaccination in men is low, and gender-neutral vaccination is estimated to be implemented only in 42 countries worldwide. Because data in penile cancer are lacking, further research is needed to study the efficacy of incorporation of HPV vaccines in male vaccination programs on preventing penile cancer and PeIN. Nurses and other members of the multidisciplinary team should take every opportunity to recommend HPV vaccination in adolescent men. Moreover, they play an important role in raising community awareness about the incidence of HPV and the related range of diseases. A practical approach is needed to incorporate HPV vaccines in vaccination programs and to optimize vaccination coverage.

Male genital lichen sclerosus, microincontinence and occlusion: mapping the disease across the prepuce.

Male genital lichen sclerosus (MGLSc) can lead to significant sexual dysfunction and urological morbidity, and is also a risk factor for premalignant disease (penile intraepithelial neoplasia and penile cancer), particularly squamous cell carcinoma. Although the precise aetiopathogenesis of MGLSc remains controversial, accumulated evidence indicates that it is related to chronic, intermittent, occluded exposure to urine. To perform spatial mapping of MGLSc across the human prepuce and assess how this supports the urinary occlusion hypothesis. Preputial samples were collected from 10 patients with clinically diagnosed MGLSc undergoing circumcision. The samples were then divided into a grid pattern and 10 punch biopsies were obtained from each section to determine the extent and distribution of the disease process across each prepuce. All 10 patients reported having urinary microincontinence, and all were histologically confirmed as having MGLSc. The most proximal aspect of the prepuce was found to be universally affected by MGLSc in all patients, whereas the most distal part was overwhelmingly shown to be the least affected area. Of the 63 MGLSc-affected regions, 62 were in direct physical contiguity with one another. The histological extent of the disease was not found to be congruent with either the severity of the symptoms reported by the patients or the clinical examination. In uncircumcised men with urinary microincontinence, after the prepuce has been replaced post micturition, small amounts of urine can pool between the juxtaposed epithelial surfaces. The proximal aspect of the prepuce is subjected to the maximum amount of occlusion and maximal contact with accumulated urine, whereas the distal prepuce is subjected to the least. Our findings suggest that accentuated contact between urine and susceptible penile epithelium due to occlusion can lead to MGLSc. Furthermore, contiguity data suggest that once established, it is possible that MGLSc advances across tissues by physical contact. This is the first study examining the changes in the preputial landscape in patients with LSc and contributes to our understanding of disease aetiology and progression.

V11-07 A VIDEO DEMONSTRATION AND CASE SERIES OF A MODIFIED SPLIT THICKNESS SKIN GRAFT TECHNIQUE USING ARTISS SEALANT® PERFORMED WITH PENILE CANCER PROCEDURES

You have accessJournal of UrologyCME1 May 2022V11-07 A VIDEO DEMONSTRATION AND CASE SERIES OF A MODIFIED SPLIT THICKNESS SKIN GRAFT TECHNIQUE USING ARTISS SEALANT® PERFORMED WITH PENILE CANCER PROCEDURES James A Churchill, Christian Fankhauser, Maurice W. Lau, Vijay K. Sangar, and Arie S. Parnham James A ChurchillJames A Churchill More articles by this author , Christian FankhauserChristian Fankhauser More articles by this author , Maurice W. LauMaurice W. Lau More articles by this author , Vijay K. SangarVijay K. Sangar More articles by this author , and Arie S. ParnhamArie S. Parnham More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002632.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Glans resurfacing and glansectomy are established procedures for the treatment of penile intraepithelial neoplasia (PeIN) and penile squamous cell carcinoma (PSCC), both commonly requiring simultaneous split thickness skin graft (STSG). Artiss Sealant® (Baxter, Wilmington, USA) is a slow-setting fibrin sealant approved for use in skin grafting procedures. Since 2019 we have performed a modified STSG technique using Artiss Sealant®, with the aim of maintaining long-term STSG viability and short length of stay (LOS). We present a video demonstrating our surgical technique in a representative case of glans resurfacing + STSG using Artiss Sealant®, with an associated case series. METHODS: We retrospectively reviewed STSG procedures using Artiss Sealant® performed simultaneously with a penile cancer procedure at a UK tertiary referral centre between February 2019 and October 2021. Outcomes measured were LOS, STSG loss, readmission within 28 days, requirement for repeat STSG procedure and disease recurrence during follow-up. One representative case of glans resurfacing + STSG was prospectively consented for clinical photography, filmed professionally and video edited for educational purposes. Audit approval was obtained from the host clinical governance committee. RESULTS: 12 cases met inclusion criteria, including 6 STSGs performed simultaneously with glansectomy, 5 with glans resurfacing and 1 with wide local excision (WLE) of penile lesion. Median age was 57 years (range 36-70), body mass index 30 (range 23-37) and Charlson Comorbidity Index 1 (range 0-3). Glansectomy cases demonstrated stage pT2 grade 2-3 (4) and pT1 grade 2 (2) PSCC; Glans resurfacing cases demonstrated pT1 grade 1-3 (2) PSCC and PeIN (3). The WLE case demonstrated PeIN. Median LOS was 30 hours (range 9-84 hours). All 12 STSGs remained viable at the first post-operative clinic review (median 8 days, range 6-17) and all remained healthy for the duration of follow-up (median 5 months, range 1-24). 1 patient was readmitted within 28 days for reasons unrelated to STSG procedure. No patient required repeat STSG procedure, and no recurrences were detected during follow-up. CONCLUSIONS: Our video demonstrates our technique for performing STSG using Artiss Sealant® simultaneously with a penile cancer procedure, with a case series demonstrating short LOS and preserved long-term STSG viability. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e923 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information James A Churchill More articles by this author Christian Fankhauser More articles by this author Maurice W. Lau More articles by this author Vijay K. Sangar More articles by this author Arie S. Parnham More articles by this author Expand All Advertisement PDF DownloadLoading ...

Exploring reflectance confocal microscopy as a non-invasive diagnostic tool for genital lichen sclerosus.

The diagnosis of genital lichen sclerosus (LS) is often confirmed by obtaining a skin biopsy, which can lead to unwanted complications and is uncomfortable in the sensitive genital area. Thus, there is a need of finding novel, non-invasive techniques that can rapidly and accurately diagnose LS. The present study investigated the potential for reflectance confocal microscopy (RCM) to diagnose LS compared with healthy penile skin and other common penile skin disorders in males. A total of 30 male patients, including patients with LS, nonspecific balanoposthitis, plasma cell balanitis and psoriasis, and healthy individuals were included and were subject to non-invasive RCM investigation. Prominent fiber-like structures, representing hyaline sclerosis, were observed in the RCM images for almost half of the patients. Differences between healthy penile skin and LS were confirmed by identifying the edged papillae on healthy skin and their absence or obscureness in patients with LS. Notably, RCM could detect the atypical honeycomb pattern referring to dysplasia in 1 patient with LS with penile intraepithelial neoplasia. In conclusion, the present study demonstrated that RCM can detect sclerosis in penile LS. RCM can potentially become a valuable tool for monitoring patients with LS for dysplasia providing a useful non-invasive diagnostic tool for genital disorders.

HPV-negative Penile Intraepithelial Neoplasia (PeIN) With Basaloid Features.

Most human papillomavirus (HPV)-independent penile squamous cell carcinomas (PSCCs) originate from an intraepithelial precursor called differentiated penile intraepithelial neoplasia, characterized by atypia limited to the basal layer with marked superficial maturation. Previous studies in vulvar cancer, which has a similar dual etiopathogenesis, have shown that about one fifth of HPV-independent precursors are morphologically indistinguishable from high-grade squamous intraepithelial lesions (HSILs), the precursor of HPV-asssociated carcinomas. However, such lesions have not been described in PSCC. From 2000 to 2021, 55 surgical specimens of PSCC were identified. In all cases, thorough morphologic evaluation, HPV DNA detection, and p16, p53, and Ki-67 immunohistochemical (IHC) staining was performed. HPV-independent status was assigned based on both negative results for p16 IHC and HPV DNA. Thirty-six of the 55 PSCC (65%) were HPV-independent. An intraepithelial precursor was identified in 26/36 cases (72%). Five of them (19%) had basaloid features, morphologically indistinguishable from HPV-associated HSIL. The median age of the 5 patients was 74 years (range: 67 to 83 y). All 5 cases were p16 and DNA HPV-negative. Immunohistochemically, 3 cases showed an abnormal p53 pattern, and 2 showed wild-type p53 staining. The associated invasive carcinoma was basaloid in 4 cases and the usual (keratinizing) type in 1. In conclusion, a small proportion of HPV-independent PSCC may arise on adjacent intraepithelial lesions morphologically identical to HPV-associated HSIL. This unusual histologic pattern has not been previously characterized in detail in PSCC. p16 IHC is a valuable tool to identify these lesions and differentiate them from HPV-associated HSIL.

Incidence of penile intraepithelial neoplasia and treatment strategies in Sweden 2000-2019.

ObjectivesTo analyse the incidence, treatment strategies and complications associated with penile intraepithelial neoplasia (PeIN) in Sweden over a period of 20 years.Materials and methodsData on PeIN from the Swedish National Penile Cancer Register were analysed regarding treatment in relation to age, size of the PeIN lesion, localization of the PeIN lesion and complications using chi‐squared tests and logistic regression. The incidence of PeIN was calculated and age‐standardized according to the European Standard population.ResultsBetween 2000 and 2019 a total of 1113 PeIN cases were reported. The age‐standardized incidence of PeIN was 1.40 per 100 000 men (95% confidence interval [CI] 1.32–1.49). An increase in incidence over time was seen, with a standardized incidence rate of 2.37 (95% CI 1.56–3.70) in 2019 compared to the baseline year, 2000. Surgical or topical treatments were given in 75.0% and 14.6% of cases, respectively. The complication rate was higher in laser surgery (12.1%, 7/58) compared to local surgery (4.6%, 16/348; P = 0.03) with an age‐adjusted odds ratio (OR) of 2.82 (95% CI 1.10–7.19; P = 0.03). Local surgery was more common than laser surgery in the last 5 years compared to the first 5 years of the study period: OR 5.75 (95% CI 2.94–11.27). Treatments with imiquimod and topical 5‐fluorouracil (5‐FU) were more common than destructive methods such as photodynamic therapy, cryotherapy, curettage and electrocautery in the last 5 years compared to the first 5 years: OR 9.48 (95% CI 2.29–39.24).ConclusionsA twofold increase in the age‐standardized incidence of PeIN was seen in Sweden over 20 years. Complications were three times more common in laser surgery compared to local surgery. Changes in treatment showed an increase of treatment strategies such as local surgery and treatment with imiquimod and topical 5‐FU over time.

Unsuccessful treatment of penile intraepithelial neoplasia with Mohs micrographic surgery.

article: Unsuccessful treatment of penile intraepithelial neoplasia with Mohs micrographic surgery - Italian Journal of Dermatology and Venereology 2021 December;156(Suppl. 1 to No. 6):20-2 - Minerva Medica - Journals

Les néoplasies intraépithéliales peniennes

Penile carcinogenesis can be superposed on vulvar carcinogenesis, with two pathways : with or without a link to HPV. Penile squamous cell carcinomas arise from precursor lesions: penile intraepithelial neoplasia (PeIN) defined by the presence of intraepithelial atypia, which can progress to invasive squamous cell carcinoma. Differentiated PeINs not linked to HPV, affect elderly men with inflammatory lesions, most often lichen sclerosus. PeINs linked to HPV, basaloid, condylomatous or condylomatous-basaloid growth affect younger men. Although clinically similar, their distinction is important, because the treatment differs with a greater risk of invasion for forms unrelated to HPV.

Incidence of penile intraepithelial neoplasia and incidence and survival of penile cancer in Denmark, 1997 to 2018.

Squamous cell carcinoma (SCC) of the penis is rare. Some studies have suggested that the incidence is increasing but the available literature is equivocal. We examined the incidence of high-grade penile intraepithelial neoplasia (PeIN), the incidence and 5-year relative survival as well as mortality of penile SCC in Denmark over the latest 20years. New cases of high-grade PeIN and penile cancer were identified from high-quality nationwide registries. Age-standardized (World) incidence rates per 100,000 person-years and average annual percentage change (AAPC) were estimated. For penile SCC, 5-year relative survival was calculated, and Cox regression was used to examine the effect of selected characteristics on mortality. Altogether, 1,070 new cases of high-grade PeIN were diagnosed (1997-2018) and the incidence increased from 0.87 to 1.84 per 100,000 person-years from 1997-1998 to 2017-2018 (AAPC = 4.73; 95% CI: 3.54-5.94). We identified 1,216 penile cancer cases (1997-2018) (95.7% SCC). The incidence of penile SCC increased slightly from 0.85 per 100,000 person-years in 1997-1998 to 1.13 per 100,000 person-years in 2017-2018 (AAPC = 1.01; 95% CI: 0.24-1.79). The 5-year relative survival of penile SCC did not change substantially, whereas the mortality tended to decrease. Penile SCC is increasing slightly in Denmark, while a pronounced increase in the incidence of high-grade PeIN is seen. The 5-year relative survival from penile cancer was relatively stable over time. Increasing exposure to HPV infection atthe population level may have contributed to the observed increase in PeIN and penile SCC. Awareness of HPV may also have contributed to the increased detection of PeIN.

Pre-cancious penile intraepithelial neoplasia. Modern terminology according to the 2016 WHO Classification of Tumors of the Urinary System and Male Genital Organs

Modern vision of pre-cancious penile intraepithelial neoplasia contained in the 2016 WHO Classification of Tumors of the Urinary System and Male Genital Organs was studied. New approaches to systematization of pre-cancious epithelial tumors of penis were reviewed in the fifth chapter of the 2016 WHO Classification called «Tumours of the penis» in section Precursor lesions. In this chapter two nosological units such as penile intraepithelial neoplasia associated with HPV infection and differentiated penile intraepithelial neoplasia not associated with NPV were proposed. We analysed patients with papulosis bowenoid, leukoplakia, penile lichen sclerosus, pseudoepitheliomatous keratotic and micaceous balanitis in Main Military Clinical Hospital named after N.N. Burdenko in accordance with different histopathological types of penile intraepithelial neoplasia. Penile intraepithelial neoplasia associated with HPV is identified in cases of papulosis bowenoid. Differential penile intraepithelial neoplasia can be found in clinical dignosis of l eukoplakia, penile lichen sclerosus, pseudoepitheliomatous keratotic and micaceous balanitis.

Surgical technique and outcomes following coronal-sparing glans resurfacing for benign and malignant penile lesions.

The aim of this study is to describe the outcomes fora modified glans-resurfacing technique for benign and malignant penile conditions in which the uninvolved glans corona is preserved in order to maintain glans erogenous sensation. A total of 13 patients underwent coronal-sparing glans resurfacing (CSGR), with follow-up every 3 months for ≥2 years. Positive surgical margin and local recurrence (LR) rates were evaluated. Surgical complications and cosmetic outcomes were also recorded. Patients were asked to complete the International Index of Erectile Function-5 (IIEF-5) questionnaire starting 12 months after the surgery. The median (interquartile range [IQR]) age and follow-up periods were 63 (53-68) years and 29 (14-38) months, respectively. Eight patients were diagnosed with primary penile squamous cell carcinoma (SCC), three had refractory lichen sclerosus, and two had penile intraepithelial neoplasia (PeIN). No surgical complications were recorded. All patients had a complete graft take and reported satisfactory cosmetic results with preserved erogenous sensation. Two cancer patients developed LR which was managed with further penile preserving surgery. The median (IQR) postoperative IIEF-5 value was 20 (17-23). This modified coronal-sparing technique was suitable for glans lesions that spare the coronal ridge and coronal sulcus. Preservation of the coronal ridge helps maintain sexual function and provides excellent cosmetic outcomes.

Clinical and dermatoscopic features of lichen planus balanoposthitis

Lichen planus (LP) is an inflammatory mucocutaneous disease characterized by pruritic, polygonal, violaceous, flat-topped papules. Wickham striae (WS) are a dermatoscopic and clinical hallmark of LP. Additional dermatoscopic findings include dotted and linear vessels, white and yellow dots, and pigmented structures. However, LP manifests with different clinical and dermatoscopic patterns according to the localization and the duration of the inflammation.1 Lichen planus balanoposthitis (LPBP) can be the sole presentation of the disease and is a risk factor for developing penile intraepithelial neoplasia.2 Dermatoscopy could facilitate the diagnosis of LPBP in uncertain cases. However, data on dermatoscopic features of LPBP are exceedingly limited.

P0673 - Treatment options and outcomes of men with Penile Intraepithelial Neoplasia (PeIN): A systematic review

P0673 - Treatment options and outcomes of men with Penile Intraepithelial Neoplasia (PeIN): A systematic review

Incidence of HPV-related Anogenital Intraepithelial Neoplasia and Cancer in Men With Diabetes Compared With the General Population.

Diabetes may increase risk of human papillomavirus (HPV)-related precancer and cancer. We estimated incidence of penile and anal high-grade intraepithelial neoplasia (hgPeIN, hgAIN) and squamous cell carcinoma (SCC) in men with diabetes compared with the entire Danish male population without diabetes. In this registry-based cohort study, we included all men born 1916-2001 and residing in Denmark (n = 2,528,756). From nationwide registries, we retrieved individual-level information on diabetes, educational level, and diagnoses of hgPeIN, hgAIN, penile SCC, and anal SCC. We used Poisson regression models to estimate incidence of hgPeIN, hgAIN, penile SCC, and anal SCC as a function of diabetes status, attained age, calendar period, and education. We estimated incidence rate ratios (IRRs) of each outcome in men with diabetes compared with nondiabetic men, both for diabetes overall and separately for type 1 (T1D) and type 2 diabetes (T2D). Men with diabetes had increased incidence rate of penile SCC compared with nondiabetic men (IRR = 1.5, 95% CI = 1.2, 1.9). We saw similar trends for anal SCC, hgPeIN, and hgAIN. The combined incidence rate of penile and anal SCC was increased in men with T2D (IRR = 1.5, 95% CI = 1.3, 1.8), but not with T1D (IRR = 0.53, 95% CI = 0.20, 1.4) compared with men without diabetes. The incidence of penile and anal high-grade intraepithelial neoplasia and SCC in men with diabetes was increased compared with men without diabetes. For penile and anal SCCs, this was primarily due to an increased risk in men with T2D.

Genital premalignant and malignant diseases: a retrospective study of male genital skin biopsies.

Genital skin malignancies are a rare entity encountered by clinicians that may result in significant morbidity and mortality. Lack of familiarity or expertise in this area among clinicians can delay appropriate management of these conditions and may result in disease progression. We performed a retrospective descriptive cohort study of male patients who received a genital skin biopsy reported by one major dermatopathology laboratory between January 2017 and December 2018 with a histological diagnosis of a premalignant or malignant condition. Patient age, type of clinician, clinical notes, genital site, type of biopsy performed, and histopathological diagnosis were evaluated. Of the 1525 male genital skin biopsies available for analysis, 5% (74/1525) were premalignant or malignant diseases. These included penile intraepithelial neoplasia (PeIN) (42/74, 57%), followed by invasive squamous cell carcinoma (SCC) (11/74, 15%), Bowenoid papulosis (BP) (9/74, 12%), basal cell carcinoma (8/74, 11%), malignant melanoma (2/74, 2.7%), extramammary Paget's (1/74, 1.4%), and metastatic cutaneous deposits (1/74, 1.4%). PeIN and BP most commonly affected the penile shaft ([18/42] 43% and [4/9] 44%, respectively), invasive SCCs most commonly affected the glans penis (4/11, 36%), and all BCCs (8/8, 100%) were located on the scrotum. Invasive SCCs were most biopsied by urologists, BP was most biopsied by dermatologists, and PeINs and BCCs were most biopsied by general practitioners. A variety of genital malignancy types were found in males. A greater understanding of male genital premalignant and malignant conditions may help guide education and further research in this area.