The Impact of Male Genital Dermatology in the Field of Andrology.

BACKGROUND: Male genital dermatological conditions occupy a distinct clinical space at the intersection of dermatology and andrology. For much of the last century they were managed in isolation, often without accurate diagnosis, with surgery as the default response to anatomical sequelae. Over the past three decades, advances in male genital dermatology have fundamentally changed this landscape, with direct and measurable consequences for urological and andrological practice.

OBJECTIVES: To review the impact of advances in male genital dermatology on the management of male genital lichen sclerosus (MGLSc), penile intraepithelial neoplasia (PeIN), penile squamous cell carcinoma (PSCC), and selected rare genital conditions, with a focus on how dermatological insights have altered urological and andrological practice.

METHODS: A review of the published literature was performed, incorporating primary studies, systematic reviews, clinical guidelines, and expert consensus documents relevant to male genital dermatology and its interface with andrology and urology.

RESULTS: Dermatological investigation established chronic occluded urinary exposure as the fundamental driver of MGLSc, providing the mechanistic basis for circumcision as definitive treatment where medical therapy fails. The refutation of HPV, Borrelia, and autoimmunity as aetiological agents, the characterisation of the LSc-dPeIN-PSCC carcinogenic sequence, and the reclassification of Zoon's balanitis as a manifestation of MGLSc have each had specific consequences for clinical decision making. The introduction of dermoscopy has improved lesion assessment and reduced unnecessary biopsy. An understanding of the triphasic age distribution of MGLSc, its association with urological procedures, and the psychosexual burden it imposes all reflect dermatologically derived knowledge with direct andrological and urological application. In rare conditions including penile melanoma, pseudoepitheliomatous keratotic and micaceous balanitis, and penoscrotal extramammary Paget's disease, multidisciplinary input from dermatology has improved diagnostic accuracy and reduced surgical morbidity.

CONCLUSIONS: Advances in male genital dermatology have transformed the understanding, diagnosis, and management of male genital disease. Shared surveillance between dermatology and andrology, with agreed thresholds for surgical escalation, offers the most effective model of care and the greatest potential for organ preservation, prevention of malignant transformation, and improvement in quality of life.