Foreskin or prepuce is the anatomical covering of male external genitalia. It covers the distal part of external surface of penis. Diseases of foreskin may manifest as an array of pathological conditions which includes nonspecific inflammation, premalignant conditions like Lichen sclerosus et atrophicus (LSA) or Balanitis xerotica obliterans (BXO) and malignant tumours like squamous cell carcinoma. Previous studies have shown strong association of squamous cell carcinoma arising in the settings of long standing lichen sclerosus of the penis. Hence, overall, benign lesions constituted 97.16% and malignant cases were reported in 2.8% of cases.

BXO is many times missed clinically and hence the definite diagnosis is made only by histopathological examination.

We studied 106 specimens of foreskin following medical indication for circumcision in a tertiary care hospital. The study period was 1.5 years and included 71 paediatric patients and 35 adult patients. Majority of the patients presented with phimosis. The chronic nonspecific inflammation was observed as the most common lesion (n=83, 77.58%) whereas granulomatous inflammation was identified in3cases (2.8%).We also observed 13 cases of Balanitis xerotica obliterans (12.15%), out of which 5 cases (38.46%) were diagnosed on clinical grounds while rest were histopathological diagnoses. The incidence of BXO in pediatric age group was 4.22%. Well differentiated Squamous cell carcinoma was reported in 3 of the cases (2.8%). Since majority of the foreskin pathologies present with clinical symptoms of phimosis, microscopic examination following circumcision is a must, to correctly detect the histopathological lesion.

Keywords: Foreskin, Balanitis xerotica obliterans, circumcision, phimosis, SCC.

1. Bostwick DG, Cheng L. Penis. In: Urologic Surgical Pathology, 3^rd Saunders; 2014. p. 859.
2. Nesca MR, Innocenzi D, Micali G. Penile cancer among patients with genital lichen sclerosus. J Am AcadDermatol 1999;41: 911-4
3. Micali G, Nerca MR, Innocenzi D. Lichen sclerosus of the glans is significantly associated with penile carcinoma. Sex Transm Infect 2001;77:226
4. Naji H, Jawad E, Ahmed HA, Mustafa R. Histopathological lesion of the prepuce after circumcision: is it a waste of resources?.Afr J paediatrSurg 2013;10:n1 64-6
5. Bale PM, Lochhead A, Martin HC. Balanitis xerotica obliterans in children. Paediatr Pathol 1987; 7:617-27
6. West DS, Papalas JA, Selim MA, Vollmer RT. Dermatopathology of the foreskin: an institutional experience of over 400 cases. J CutanPathol 2013;40(1):11-18
7. Morris BJ, Krieger JN. Penile inflamm-atory skin disorders and the preventive role of circumcision. Int J Prev Med. 2017;8:32
8. Rajiah K, Veettil SK, Kumar S, Mathew EM. Study on various types of infections related to balanitis in circumcised or uncircumcised male and its causes, symptoms and management. Afr J Pharm Pharmacol 2012;6(2):74-83.
9. Fernando AS, Rattan R, Bott SRJ. Metastatic Crohn’s disease involving the foreskin – a case report and literature review. J Clin Urol. 2013;6(1):22-23
10. Mahmood N, Afzal N, Joyce A. Sarcoid-osis of the penis. Brit J Urol. 1997, 80:155
11. Plaza T, Lautenschlager S. Penis swelling due to foreign body reaction of silicone. J Dtsch Dermatol Ges. 2010;8:689-691.
12. Alcantara LSI et al. Granulomas of the penis: a rare compication of intravesical therapy with Bacillus Calmette- Guerin. An Bras Dermatol 2011;86:759-762
13. Bunker CB, Shim TN. Male genital lichen sclerosus. Indian J Dermatol 2015;60(2): 111-117
14. Innocenzi D et a. Penile lichen sclerosus correlates between Histopathological features and risk of cancer. Acta Dermatovenerol Croat 2006;14(4):225-9
15. Liatsikos EN, Perimemnis P, Dandinis K, Kaladelfou E, Barbalias G. Lichen sclerosus at atrophicus. Findings after complete circumcision. Scand J Urol Nephrol 1997; 31:453-6
16. Velazquez EF, Cubilla AL. Lichen sclerosus in 68 patients with squamous carcinoma of the penis: frequent atypias and correlation with special carcinoma variants suggests a precancerous role. Am J SurgPathol 2003;27:1448-1453.

Dr Poonam Dattaram Gad

Department of Pathology, Government Medical College and Hospital,

Miraj, Maharashtra, India

Contact no. 9765795886, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.