Penile cancer among patients with genital lichen sclerosus

Background: Genital lichen sclerosus (LS) has sporadically bt en reported t o be associated with penile squamous cell carcinoma (SCC). Objective: The purpose of this study was to assess the risk of malignant de generation in a series of male patients affected by genital LS. Methods: All cases of histologically proven epithelial malignancy associate d with penile LS recorded in our pathology files over a 10-year period (198 7-1997) were reviewed, Assessment or presence of human papillomavirus (HPV) was performed from paraffin-embedded tissues using polymerase chain reacti on (PCR). Results: Five of 86 white and uncircumcised men with genital LS (mean age a t diagnosis, 53 years; range, 22-83 years) showed malignant or premalignant histopathologic features: 3 had SCC one had erythroplasia of Queyrat (unif ocal SCC in situ), and one verrucous carcinoma. The average lag time from o nset of LS was 17 years (range, 10-23 years). Histologically, transition fr om LS to frank neoplastic foci was evident in all cases of SCC. In these SC C cases, areas of epithelial dysplasia were well evident at the tumor perip hery. In die remaining cases, the histologic findings were consistent with erythroplasia of Queyrat and verrucous carcinoma. PCR detected HPV 16 infec tion in 4 of the 5 cases; one SCC patient was negative for HPV. Conclusion: Malignant changes were associated with 5.806 of the cases of pe nile LS in our series. Therefore patients with genital LS are at considerab le risk of the development of penile SCC, as well as other epithelial and i n situ carcinomas, namely verrucous carcinoma and erythroplasia of Queyrat. HPV infection probably plays a major role because 4 of 5 patients were pos itive for HPV. Histologically, epithelial dysplasia may represent a precanc erous stage before the development of neoplasia in atrophic nonproliferativ e LS lesions, as its presence at the tumor periphery in our SCC biopsy samp les seemed to suggest.