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

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.