2021-35/ August 30
Contributors: Maiara Ferreira de Souza, Nathanael de Freitas Pinheiro Jr., Daniel Athanazio

A male in his 60s with history of prostate cancer status post radiation treatment. Transurethral resection of the prostate is performed.


1. In this particular area, what is the diagnosis?

a. Lichen sclerosus

b. Lichen sclerosus + Nevus elasticus

c. Amyloidosis

d. Fibrous scar

e. Scleroderma

Lichen sclerosus + Nevus elasticus

Lichen sclerosus is a chronic dermatosis that usually involves the anogenital area. It is a cause of chronic inflammation implicated in the carcinogenesis of some types of HPV negative squamous cell carcinomas. Another rare condition associated with lichen sclerosus is a prominent deposition of elastic fibers in deep dermis (including vessels). This lesion is more commonly referred as nevus elasticus. Such association is rare, although documented in both vulvar and penile lichen sclerosus.

Shiba and colleagues studied 22 cases of lichen sclerosis (18 vulval and 4 extra-genital) and reported moderate or advanced increase in elastic fibers in the mid to lower dermis in most cases (14/22). They speculated that elastic fiber accumulation is a form of repair in response to loss of elastic in the upper dermis.

This rare observation probably mirrors the stromal elastosis which is well described in the breast, with or without association with carcinoma. Interestingly, the association between stromal elastosis and breast carcinoma is associated with mammography screening detection and have better prognosis.

1. Chen Y, Klingen TA, Wik E, Aas H, Vigeland E, Liestøl K, Garred Ø, Mæhlen J, Akslen LA, Lømo J. Breast cancer stromal elastosis is associated with mammography screening detection, low Ki67 expression and favourable prognosis in a population-based study. Diagn Pathol. 2014 Dec 19;9:230.

2. Kacerovska D, Michal M, Hora M, Hadravsky L, Kazakov DV. Lichen sclerosus on the penis associated with striking elastic fibers accumulation (nevus elasticus) and differentiated penile intraepithelial neoplasia progressing to invasive squamous cell carcinoma. JAAD Case Rep. 2015 May 25;1(3):163-5.

3. Parfrey NA, Doyle CT. Elastosis in benign and malignant breast disease. Hum Pathol. 1985 Jul;16(7):674-6.

4. Sabater-Marco V, Navalon-Verdejo P, Sabater-Abad VJ. Balanitis Xerotica Obliterans Associated With Differentiated Penile Intraepithelial Neoplasia and “Bramble-Bush” Elastic Fibers Accumulation: A Finding Not Specific for Penicillamine Intake. Am J Dermatopathol. 2020 Nov;42(11):885-888.

5. Sánchez Yus E, Aguilar A, Requena L, Urbina F, Cristobal MC. Nevus elasticus and lichen sclerosus et atrophicus on the vulva. Cutis. 1990 Apr;45(4):252-5.

6. Shiba Y, Ono K, Akiyama M, Fujimoto N, Tajima S. Increase of elastic fibers in lichen sclerosus et atrophicus. J Cutan Pathol. 2014 Aug;41(8):646-9. doi: 10.1111/cup.12342.

7. Staricco RG, Mehregan AH Nevus elasticus and nevus elasticus vascularis. Arch Dermatol. 1961 Dec;84:943-7.

Maiara Ferreira de Souza
Nathanael de Freitas Pinheiro Junior
Daniel Athanazio
Federal University of Bahia
Imagepat, Laboratory of Pathology
Salvador, Bahia, Brazil


Penis; Lichen sclerosus; Nevus elasticus