Is routine histology necessary in circumcision?

SummaryObjectiveA retrospective audit of all patients circumcised during a calendar year (01/01/2008–31/12/2008) to determine whether routine specimen histology in circumcision is necessary.Patients and methodsThe records of 114 patients (51 adult, 63 paediatric) circumcised in a year were retrospectively reviewed. Indications for circumcision were phimosis, recurrent balanoposthitis and suspected squamous cell carcinoma (SCC). Data were collected on the following areas: patient age, indication, pre-operative and histological diagnosis. Pre-operative diagnosis was compared with histological diagnosis to determine whether histology differed from the clinical impression.ResultsA total of 31 patients had histologically confirmed lichen sclerosus (22 adult, 9 paediatric). Of these patients, 26 (84%) were predicted pre-operatively. There were three adult patients diagnosed with squamous cell carcinoma and all of these cases were predicted pre-operatively. There were no cases of SCC or lichen sclerosus diagnosed in patients clinically thought to have normal foreskin.ConclusionsThe data indicate that routine histology is not necessary in adult and paediatric circumcision and should be reserved for patients with suspected lichen sclerosus or carcinoma.