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

• Published in: BJU international 2012-03, Vol.109 (5), p.776-779
• Main Authors: Abdelbaky, Ather M., Aluru, Pavan, Keegan, Philip, Greene, Damien R.
• Format: Article
• Language: English
• Subjects: Adult; Age; Aged; Aged, 80 and over; balanitis xerotica obliterans; Biological and medical sciences; Cancer surgery; Circumcision; Dermatology; Genital cancers; glanuloplasty; Hospitals; Humans; Incidence; lichen sclerosus et atrophicus; Lichen Sclerosus et Atrophicus - epidemiology; Lichens; Male; Medical sciences; Men; Middle Aged; Nephrology. Urinary tract diseases; penile cancer; Penile Diseases - epidemiology; Penile Neoplasms - surgery; penile reconstruction; Penis; Plastic surgery; Psoriasis. Parapsoriasis. Lichen; Reconstruction; Retrospective Studies; Skin; Skin & tissue grafts; Skin Transplantation - adverse effects; squamous cell carcinoma; Surgery; Urologic Surgical Procedures, Male - adverse effects
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2011.10368.x

Study Type – Therapy (case series) Level of Evidence 4 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 identified. • 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 first 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.