Lichen Sclerosus of the Penis: Understanding Your Pathology Report

Section Editor: Trevor Flood MD FRCPC
October 25, 2026

Lichen sclerosus of the penis is a long-lasting inflammatory skin condition that affects the glans (the head of the penis) and the foreskin. Over time, it makes the skin thin, pale, and scarred. Lichen sclerosus is not cancer and is not an infection, and it cannot be passed to a sexual partner. Most men respond well to treatment. However, men with lichen sclerosus have a higher risk of developing penile cancer, so regular follow-up is important.

This article explains what lichen sclerosus of the penis is, how the diagnosis is made, and what the findings in a lichen sclerosus pathology report mean. It also explains how lichen sclerosus is linked with precancerous changes and penile cancer.

Older reports and some doctors may call lichen sclerosus of the penis balanitis xerotica obliterans, or BXO. Both names describe the same condition, and the newer name, lichen sclerosus, is now preferred. Lichen sclerosus also affects women, and our article on lichen sclerosus of the vulva describes that condition.

Who gets lichen sclerosus of the penis?

Lichen sclerosus of the penis can affect males of any age. It is most common in boys and in middle-aged and older men. Lichen sclerosus affects women much more often than men. In males, it almost always affects those who are not circumcised, and it is rare in men who were circumcised as babies. It is often found in foreskins removed because of phimosis, a tight foreskin that cannot be pulled back.

What causes lichen sclerosus of the penis?

The exact cause of lichen sclerosus of the penis is not known. The leading explanation is that small amounts of urine become trapped between the foreskin and the glans over many years. This trapped urine irritates the skin and causes long-lasting inflammation, which leads to scarring. Factors linked with lichen sclerosus of the penis include:

Not being circumcised. The foreskin creates the warm, moist space where urine can be trapped.
Leaking small amounts of urine. Dribbling after urination, including after prostate surgery, keeps the skin wet.
Obesity. Excess weight can bury the penis in surrounding skin, which traps moisture.
Changes in the anatomy of the penis. Conditions such as hypospadias, where the urethra opens on the underside of the penis, are linked with lichen sclerosus.
Injury to the skin. Lichen sclerosus can appear in skin that has been injured, such as after surgery or a piercing.

What are the symptoms of lichen sclerosus of the penis?

Lichen sclerosus of the penis can cause no symptoms at first, and it may be found only when a foreskin is examined. As it progresses, it may cause:

Pale or white patches. The skin of the glans and foreskin becomes white, shiny, and thin, and may show small bruises.
Itching, soreness, or tearing. The thin skin can split, especially during sex.
A tight foreskin. Scarring can make the foreskin difficult or impossible to pull back.
Problems urinating. Scarring at the opening of the urethra can cause a weak or spraying stream or pain when urinating.
Painful erections. A tight, scarred foreskin can make erections uncomfortable.

How is the diagnosis made?

Lichen sclerosus of the penis is often diagnosed by a doctor based on how the skin looks. If the diagnosis is uncertain, a doctor may take a small tissue sample, called a biopsy. A biopsy is especially important if there is a red patch, a nonhealing sore, or a thickened area. These can signal precancerous change or cancer. Lichen sclerosus is also commonly diagnosed when a foreskin removed during circumcision is examined.

A pathologist examines the tissue under the microscope. In lichen sclerosus, the pathologist sees a thinning of the skin’s surface layer and a band of scar-like tissue just below it, along with immune cells. The next section describes these changes. Early lichen sclerosus and lichen sclerosus treated with steroid creams can look less typical. In these cases, the report may say the findings are consistent with or suggestive of lichen sclerosus.

Microscopic findings in your report

A lichen sclerosus pathology report often describes the changes the pathologist saw in the skin of the penis. Terms you may see include:

Hyperkeratosis. A thickened layer of keratin, the tough protein on the surface of the skin.
Epidermal atrophy. Thinning of the epidermis, the surface layer of the skin.
Vacuolar degeneration or interface change. Damage to the deepest cells of the epidermis, where it meets the tissue below.
Dermal sclerosis or hyalinization. A band of pale, scar-like collagen in the upper dermis, the layer of tissue below the epidermis. This is the most characteristic finding in lichen sclerosus.
Lichenoid inflammation. A band of immune cells called lymphocytes just below the scar-like collagen.

Penile intraepithelial neoplasia and cancer in lichen sclerosus

Long-lasting inflammation from lichen sclerosus of the penis can lead to genetic changes in the squamous cells of the skin. Over time, these changes can cause a precancerous condition called differentiated penile intraepithelial neoplasia (PeIN). Differentiated PeIN can then develop into HPV-independent squamous cell carcinoma of the penis.

Because of this link, the pathologist checks every lichen sclerosus specimen carefully for PeIN and cancer. Your report will usually state whether the pathologist found PeIN or invasive carcinoma. A result such as “negative for intraepithelial neoplasia and malignancy” means the pathologist found no precancerous change or cancer in the tissue examined.

Studies estimate that about 2 to 13 in 100 men with lichen sclerosus of the penis develop penile cancer, although the risk is lower with good treatment and follow-up. Viewed the other way, most men with lichen sclerosus never develop penile cancer, even over many years. Lichen sclerosus is found in the skin next to or between one-third and one-half of penile cancers.

What happens after the diagnosis?

After lichen sclerosus of the penis is diagnosed, the next steps depend on the symptoms, the extent of scarring, and whether any precancerous change was found. Care may involve a dermatologist, a urologist, or both. Options your care team may discuss include:

Strong steroid creams or ointments. A very strong steroid ointment, such as clobetasol, is usually the first treatment and is applied for several weeks. About 6 to 7 in 10 men respond well to this treatment and general skin care.
General skin care. Using a soap substitute and moisturizer, keeping the area dry, and making sure the urethra is fully emptied after urinating can reduce irritation.
Circumcision. Removing the whole foreskin cures lichen sclerosus in most men whose symptoms continue despite treatment, or who have a tight foreskin. The removed foreskin is sent to a pathologist, who checks it for PeIN and cancer.
Treatment of the urethral opening. If scarring narrows the urethral opening, a minor operation may be needed to widen it.

Even after successful treatment or circumcision, the risk of penile cancer is lower but not zero. Regular self-examination and follow-up visits are recommended. Any new red patch, lump, or sore that doesn’t heal should be checked by a doctor and may require a biopsy.

Questions to ask your doctor

Does my report confirm lichen sclerosus, or is it only suggestive of lichen sclerosus?
Was any penile intraepithelial neoplasia or cancer found?
Which areas of my penis are affected?
How should I use my steroid ointment, and for how long?
Would circumcision help in my situation?
Is the opening of my urethra affected?
What is my risk of developing penile cancer?
How often should I have follow-up visits?
What changes should I watch for between visits?
Can lichen sclerosus affect my sexual function?