Genital Dermatology

Background: Hypospadias is a congenital abnormality of the penis characterised by the urethra abnormally opening onto the ventral penis.It affects 1 in 150 male births and is the most common birth defect of infant males.Up to 10% of those who undergo childhood surgical repair develop complications in adulthood such as meatal stenosis that results in obstructed flow, retained urine and thus a predisposition to recurrent balanitis and urinary tract infections.We report a case of penile squamous cell carcinoma (SCC) following childhood hypospadias repair.Case: A 46-year-old man from a regional centre presented with a 20 × 20 mm erythematous, firm, irregular mass draining purulent fluid on the ventral surface of his distal penile shaft.His past medical history was significant for proximal hypospadias repair and circumcision at 4 years of age.At age 26, the patient developed meatal stenosis following his surgical repair resulting in chronic obstructive voiding symptoms and recurrent urinary tract infections.The patient denied any history of tobacco use, sexually transmitted infections (STIs) or psoralen-ultraviolet photochemotherapy.The penile lesion was excised and histopathological analysis revealed moderately differentiated keratinising SCC with associated balanitis xerotica obliterans.The lesion extended from the penile skin to the urethra.PET-CT Staging and sentinel lymph node biopsies excluded nodal or metastatic spread.The patient has ongoing multidisciplinary surveillance and has been recurrence-free now for 24 months.Conclusion: To our knowledge, our case represents the second reported case of penile SCC following childhood hypospadias repair in the literature and the first in Australia.In our case, chronic penile inflammation from meatal stenosis likely contributed to the patient's penile SCC pathogenesis.Our case highlights a rare aetiological risk factor for penile SCC.More importantly, it emphasises again the importance of longitudinal, multidisciplinary care for penile cancer patients in producing optimal patient outcomes.