Lichen sclerosus and phimosis – discrepancies between clinical and pathological diagnosis and its consequences

Abstract Objectives To assess the accuracy of clinical diagnoses and the true incidence of lichen sclerosus (LS) in patients with phimosis. Patients and methods The 92 adult male patients who were qualified for circumcision due to phimosis, were included in the study. The patients were diagnosed clinically by a urologist and dermatologist before the surgical procedure. After the circumcision, the resected foreskins were examined by two independent uropathologists. Results Pre-operative clinical diagnosis of LS was established in 54 patients (58.7%); healthy-looking skin in 26 (28.3%) and other penile diseases in 12 (13.1%) patients. After histopathological examination, the diagnosis of LS was established in 62 patients (67.4%), but only in 44 patients with previous LS clinical diagnosis. LS was histopathologically confirmed in 18 other patients with clinically diagnosed healthy skin (n=17) or lichen planus (LP) (n=1). Healthy skin was histopathologically confirmed in 10 cases in patients diagnosed clinically before as LS. Other 15 histopathological diagnoses were Zoon balanitis (n=3), non-specific balanitis (n=5), LP (n=1), psoriasis (n=1), invasive penile cancer (n=3), Bowen's disease (n=1), Penile intraepithelial neoplasia (PeIN) 2 usual type (n=1). Conclusions Lichen sclerosus has been revealed as the most common histopathological diagnosis in patients undergoing circumcision in our study. Histopathological examination seems to be necessary to exclude this disease.