P2.182 Male Genital Dermatoses in HIV

Abstract

Background: Little information exists about penile squamous cell carcinoma (PSCC), penile carcinoma in situ (PCIS) and male genital lichen sclerosus (MGLSc) in HIV. Methods: A retrospective review of case notes was performed on HIV-positive men who had presented to specialised Male Genital Dermatoses Clinics between May 2011 and February 2013. Results: 39 men were identified. The mean age at diagnosis was 48 years (range 26-71 years). The mean diagnostic delay was 20 months (range 1-72 months). 35 were uncircumcised at presentation (4 were circumcised at birth/childhood). The majority of the cases had PCIS (21); 8 had MGLSc, 2 had lichen planus (GLP), 2 had PSCC and the remaining cases had more than one diagnosis (1 had PSCC and MGLSc, 2 had PSCC and PCIS, 3 had PCIS and MGLSc); 6 men had co-existing anal dysplasia (2 had anal SCC); 36 were on ARVs. All genital dermatoses were treated according to our conventional practise. The majority (31) is in remission; 6 have residual disease and receive ongoing treatment (1 GLP, 1 MGLSc and 4 PCIS); 2 have been lost to follow-up; most (32) have been circumcised (including 4 circumcised at birth/childhood). 1 has a short foreskin hence circumcision is not indicated. Conclusion: Advances in ARV treatment have improved the survival of individuals with HIV. This has led to increased interest in long-term morbidities, including cancer. MGLSc and PCIS can progress to invasive cancer. The risk of PSCC in HIV despite ARV treatemnt is null5-6. The presence of the foreskin confers cancer risk. Uncircumcised HIV men should be counselled about the risk of PSCC. There may be an argument for prophylactic circumcision in high-risk cases such. Certainly, clinicians should enquire about the genital health of HIV-positive men and undertake regular (ano) genital examination at follow-up.