The authors distinguish between undifferentiated PeIN, which is strongly linked to human papillomavirus (HPV), and differentiated PeIN, which is associated with lichen sclerosus (LSc). While topical therapies and cryotherapy are utilised, the research highlights that surgical intervention, particularly circumcision, serves as the primary treatment for most cases.

The findings demonstrate that specialised multidisciplinary care leads to excellent outcomes, with only a small percentage of patients progressing to invasive cancer. Furthermore, the source advocates for HPV vaccination and smoking cessation as vital components of a comprehensive preventative strategy.

While radical orchidectomy remains the traditional standard of care due to the concern that these are malignant lesions, modern advancements in high-resolution ultrasonography have led to the increased detection of these lesions, which are more likely to be benign.

Consequently, testis-sparing surgery (TSS) for specific cases, particularly when tumour markers are negative, or the patient has a solitary testicle, can be offered to preserve fertility and hormone function. The study highlights the role of intraoperative frozen section analysis to differentiate between benign and malignant tissue before proceeding with full organ removal. Despite broad consensus on using ultrasound as a primary diagnostic tool, discrepancies still exist regarding exact size thresholds for surveillance and the necessity of additional biopsies to check for precancerous cells.

Ultimately, the guidelines advocate for a multidisciplinary approach that balances effective cancer control with the preservation of fertility and hormonal function.

Professor Asif Muneer is a leading authority on small testis lesions and manages a high volume of cases from all over the UK.