Histopathological assessment practices in adult male circumcision and detection of lichen sclerosus: a retrospective single-centre study.

OBJECTIVE

To investigate histopathological assessment practices following medical circumcision, analyse the prevalence of lichen sclerosus (LS) and assess the management of circumcised LS patients.

MATERIAL AND

METHODS

This retrospective study was conducted at Umeå University Hospital. A total of 416 patients aged ≥18 years who underwent medical circumcision between 2016 and 2023 were included. The variables investigated were the frequency of histopathological diagnosis of preputial tissue, pre- and post-surgery treatment, further management and the prevalence of LS.

RESULTS

The mean (standard deviation [SD]) age of included patients was 47 (21) years. Before circumcision, 34% (141/416) of the study population had received treatment with potent or ultrapotent topical corticosteroids. A pre-operative diagnosis of LS was set in 4.8% (20/416) of the patients. Histopathological analysis of circumcised material was performed in 44% (183/416) of cases. Amongst these, LS was confirmed in 60% (110/183). Amongst the patients with histologically confirmed LS, 13% (14/110) received a recorded diagnosis of LS. A total of 15% (16/110) of the patients with LS were either referred to a dermatovenereologist and/or received treatment with an ultrapotent topical corticosteroid.

CONCLUSIONS

LS appears to be both underdiagnosed and not adequately treated in patients undergoing medical circumcision. Less than half of the circumcised specimens were analysed, which means a risk of missing LS and potential dysplastic changes. Most patients with LS did not receive adequate diagnosis and treatment after surgery. Failure to diagnose LS limits patient awareness, follow-up and appropriate care, factors that may contribute to disease progression and increased cancer risk.