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The diagnosis and management of male genital lichen sclerosus: a retrospective review of 301 patients
Author(s) -
Kravvas G.,
Shim T.N.,
Doiron P.R.,
Freeman A.,
Jameson C.,
Minhas S.,
Muneer A.,
Bunker C.B.
Publication year - 2018
Publication title -
journal of the european academy of dermatology and venereology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.655
H-Index - 107
eISSN - 1468-3083
pISSN - 0926-9959
DOI - 10.1111/jdv.14488
Subject(s) - medicine , lichen sclerosus , retrospective cohort study , sex organ , dermatology , disease , biopsy , surgery , genetics , biology
Abstract Introduction Male genital lichen sclerosus (MGLSc) is an acquired, chronic, inflammatory skin disease that is associated with significant morbidity and squamous cell carcinoma of the penis ( PSCC ). However, some clinical, diagnostic and management controversies endure, including the relationship with penile intraepithelial neoplasia (Pe IN ). Objectives To clarify clinical presentations, diagnostic approaches, histological findings, response to treatment and the relationship with Pe IN . Methods Retrospective review of patients with a diagnosis of MGLS c who attended a specialist male genital dermatoses clinic. Results 301 patients were identified: 260 had isolated MGLS c and 41 both MGLS c and Pe IN . Referrals were made from the local Urology and Andrology departments (128), primary care (89), GUM (54), other dermatology departments (28) and other specialties (2). In isolated MGLS c, 94.6% were diagnosed clinically with 93.5% accuracy (based on data from subsequent circumcisions). In combined MGLS c/Pe IN , 85.4% were diagnosed following diagnostic biopsy and 14.6% retrospectively after circumcision. In isolated MGLS c, 50% were treated topically, and 50% required surgery. In MGLS c/Pe IN , 78% required surgical interventions. In isolated MGLS c, 92.2% achieved resolution of symptoms, 3.5% were awaiting procedures, and 4.8% were receiving ongoing topical therapy. In MGLS c/Pe IN , 90.2% achieved clearance, 2.4% were waiting surgery, and 7.3% were treated topically. Only 2.7% reported ongoing symptoms, all in patients treated surgically. None progressed to PSCC . Discussion MGLS c is generally a disease of the uncircumcised; the majority of cases of MGLS c are accurately diagnosed clinically; suspected Pe IN or PSCC requires histological confirmation; circumcision histology can be non‐specific; most men are either cured by topical treatment with ultrapotent corticosteroid (53.1%) or by circumcision (46.9%); surgical intervention is required in most cases of concomitant MGLS c and Pe IN ; the majority of patients with MGLS c alone or with MGLS c and Pe IN remit with this approach; effective management appears to negate the risk of malignant transformation to PSCC .