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Presented by Jonathan Epstein, MD and prepared by Armen Khararjian, MD
This case talks about:
A 46 year old male was noted to have a lesion on the foreskin which was resected.
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1. Question
Week 614: Case 3
A 46 year old male was noted to have a lesion on the foreskin which was resected.
Correct
Answer: Lichen sclerosis et atrophicus (LSA)
Histology: Areas of the skin show thinning of the squamous epithelium with superficial dermal pallor and underlying dense collagen with a sparse lymphocytic infiltrate.
Discussion: The findings are typical of LSA. The lesion lacks the acanthosis and interface dermatitis of lichen planus. Syphilis typically also has an interface dermatitis and numerous plasma cells. LSA is now recognized to be a precursor to usual squamous cell carcinoma of the penis and can be associated with PeIn. However, in the current case there is an absence of cytological atypia. LSA and usual squamous cell carcinoma is unrelated to HPV in contrast to basaloid PeIN and basaloid carcinoma which are strongly HPV driven.
Incorrect
Answer: Lichen sclerosis et atrophicus (LSA)
Histology: Areas of the skin show thinning of the squamous epithelium with superficial dermal pallor and underlying dense collagen with a sparse lymphocytic infiltrate.
Discussion: The findings are typical of LSA. The lesion lacks the acanthosis and interface dermatitis of lichen planus. Syphilis typically also has an interface dermatitis and numerous plasma cells. LSA is now recognized to be a precursor to usual squamous cell carcinoma of the penis and can be associated with PeIn. However, in the current case there is an absence of cytological atypia. LSA and usual squamous cell carcinoma is unrelated to HPV in contrast to basaloid PeIN and basaloid carcinoma which are strongly HPV driven.
