Characteristics of NonHPVRelated Precursor Lesions

Characteristics of non-HPV-related precursor lesions are presented in Fig. 1.2. Lichen sclerosus (LS) is a chronic inflammatory atrophic condition of unknown etiology, which most commonly affects the anogenital area (85-98%), especially in women.60,61 Because the epithelium is not always atrophic, the term LS is preferred over that of LS et atrophicus. In men, LS affects most commonly the foreskin and to a lesser extent the glans of the penis where it gives symptoms of pruritus, burning, and soreness. Clinical evaluation shows areas of pale atrophic and sclerotic plaques (patches).62 Histopathological evaluations show either an hyperplas-tic or an atrophic epithelium without cytonuclear atypia, a variable degree of interface dermatitis, homogenization of the underlying stroma, mild vasocongestion, and a variable infiltrate.

Lichen sclerosis showing typically an atrophic epithelium with homogenisation of the underlying stroma,multiple blood vessels and a variable lymphocytic infiltrate. MIB-1 positive nuclei are only found at the basal layer and the lesions are p16 negative.

Fig. 1.2 Characteristic non-HPV-related lesions of the penis

Lichen sclerosis showing typically an atrophic epithelium with homogenisation of the underlying stroma,multiple blood vessels and a variable lymphocytic infiltrate. MIB-1 positive nuclei are only found at the basal layer and the lesions are p16 negative.

Fig. 1.2 Characteristic non-HPV-related lesions of the penis

The association between LS with vulvar cancer is well established. Studies of large groups of women with vulvar LS have shown that the risk of vulvar SCC is 4-5%.61,63 In view of the resemblance of penile and vulvar cancer, LS is likely to be a risk factor of penile cancer as well. Indeed, cumulative evidence suggests that LS indeed reflects a precancerous condition for penile SCC, preceding up to 30% of the penile carcinomas, particularly those unrelated to HPV.38,62,64,65 A 10-year follow-up study of 86 men with LS reported that nearly 6% of the patients developed penile cancer, very similar to that of carcinomas occurring in vulvar LS patients.66 Although the vast majority of LS cases are negative for HPV, the prevalence of hrHPV is higher in LS patients compared to controls.66 In addition, LS might co-exist with conditions of Bowen's disease or EQ.41

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