Case Number : Case 1728 - 11 January - Dr Hafeez Diwan Posted By: Guest

Here we have an intriguing Spot Diagnosis Case from Dr Hafeez Diwan.

Cheers, Geoff Cross - DermpathPRO Projects

This is a difficult case(for me)

First images show a  hyperplastic verrucous lesion, with thick epidermal basal membrane that would define lichen sclerosis Et atrophicus hypertrophic variant.  Last imgs show an infiltrative squamous lesion that would define Verrucous Carcinoma. I think this is infiltrative because of abnormal absence of basal layer and desmoplastic reaction around it. 

I agree we see lichen sclerosus, appart from that for me there is a transition of differentiated Pein to penile squamous cell carcinoma (usual type). Picture 7 shows the aforementioned transition.

Penile SCC originating from a Lichen sclerosus

Yes, I think you are right, Raul! 

Yes SCC on top of Ls

The prototypic natural history of the differentiated penile intraepithelial neoplasia (retained squamous maturation associated with basal cell atypia) arising in the setting of lichen sclerosus and evolving towards invasive penile squamous cell carcinoma, usual type.

Yes, lichen sclerosus and invasive squamous carcinoma from differentiated PeIN.

Invasive squamous cell carcinoma arising in association with lichen sclerosus.