title: Is the association between balanitis xerotica obliterans and penile carcinoma underestimated?
abstract: OBJECTIVE
  To determine the incidence of balanitis xerotica obliterans (BXO) in a consecutive series of penile carcinomas in one centre, as BXO is a common penile disease that usually involves the prepuce and glans, and there have been sporadic case reports of the association between BXO and penile carcinoma, although it is uncertain if there is a specific causal relationship.
  
  
  METHODS
  The reported incidence of penile carcinoma in patients with BXO is 2.6-5.8%, leading some to advocate circumcision in all cases, with close follow-up in those with persistent glanular disease. We prospectively analysed all cases of penile cancer referred to the unit over a 54-month period, to determine the prevalence of BXO.
  
  
  RESULTS
  In all, 155 patients with penile malignancy were reviewed, 44 of whom had BXO (28%). This group included 34 men with squamous cell carcinoma and 10 with carcinoma in situ; in 39, BXO and malignancy presented synchronously. In three other cases, cancer occurred in the background of chronic persistent BXO; in two cases penile cancer was truly metachronous. The tumours with associated BXO tended to be of lower stage and grade, and the patients presented when younger, but this was not statistically significant.
  
  
  CONCLUSIONS
  A significant proportion of patients with penile malignancy have a histological diagnosis of BXO. We think that patients presenting with long-standing BXO and those in whom BXO has not resolved after circumcision warrant biopsies and a careful follow-up.
authors.affiliation: Department of Urology, St George's Hospital, Tooting, London, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Pietrzak
authors.forename: Paul
authors.initials: P
authors.lastname: Hadway
authors.forename: Cathy M
authors.initials: CM
authors.lastname: Corbishley
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Watkin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001446:Balanitis / Q000473:pathology*; D002278:Carcinoma in Situ / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010412:Penile Neoplasms / Q000473:pathology*; D011230:Precancerous Conditions / Q000473:pathology*; D011446:Prospective Studies