Why biopsy is important in adult with balanitis xerotica obliteranes (BXO) or lichen sclerosis foreskin in phimosis (tight foreskin)

There are some association of skin cancer with BXO. In one of the series, incidence of skin cancer is reported 5.8%.  

In other series, incidence of BXO found adjacent to penile skin cancer is 33%. These findings raised a question whether BXO is pre-malignant condition. 

It is important to do biopsy of all BXO or lichen sclerosis foreskin to confirm the diagnosis and to rule out the concomitant skin cancer. Dr. Khan sends all foreskin with BXO for biopsy after the circumcision. 

Circumcision is strongly indicated if your foreskin shows signs and symptoms of BXO or lichen sclerosis which is causing tight foreskin. 

The British Association of Dermatologists has issued a guideline about MALE GENITAL (PENIS) LICHEN SCLEROSUS

Excellent circumcision result - parents' feedback.

21st September 2016

Written by a father at Leyton Healthcare 4th Floor

Good explanation and reassuring . Very clean clinic . All disposable instruments were used -all antiseptic procedures were maintained to the highest standard. Perfect procedure with perfect result . Post op care was good with clear instructions. Even called after procedure to check the progress. No hesitation in recommending the surgeon - fantastic

Surgeon from London

Father of a child  

Newborn Male Circumcision with Parental Consent Is Both Legal and Ethical.

Recently Journal of law,  medicine and ethics published a report that parental consent for newborn male circumcision is both legal and ethical. Please see report below:

"Newborn male circumcision is a minor surgical procedure that has generated significant controversy. Accumulating evidence supports significant health benefits, most notably reductions in urinary tract infections, acquisition of HIV and a number of other sexually transmitted infections, penile cancer, phimosis, paraphimosis, balanitis and lichen sclerosis. While circumcision, like any surgical procedure, has risks for complications, they occur in less than 1 in 500 infants circumcised and most are minor and require minimal intervention. The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) believe that health benefits of circumcision outweigh the risks. For this reason, the AAP believes that parents should be allowed to make the decision concerning circumcision of their male infants after receiving non-biased information on health risks and health benefits."

© 2016 American Society of Law, Medicine & Ethics.

Reference:  J Law Med Ethics. 2016 Jun;44(2):256-62.doi: 10.1177/1073110516654119.

Circumcising older boys

Circumcision in older children can be quite challenging under local Anesthesia in community circumcision clinic .  

Our practice is to apply EMLA local Anesthetic cream 45-60 minutes before the procedure. We give mild sedation (midazolam) 20 minutes before the circumcision in older children. 

Procedure will be performed under local anaesthesia (short acting - Lignocaine and long acting - Chirocaine). We wait 5-10 minutes after local anesthesia to maker sure the procedure will be pain free. Parents will accompany the child during the procedure. There is screen between surgeon and child in the designated theatre so that child will not get upset by seeing the procedure or equipment. 

Children watch cartoon or film on phone or iPad during the procedure. child will get lolly pop and bravery sticker at the end of the procedure. Our staff attends and reassure the parents and child during the procedure. 

Please see the feedback from the mother: 

27th August 2016

Written by a mother at Thornhill Circumcision Centre

"I would like to thank Dr Khan and his wonderful team for the amazing service we received today. My son was circumcised by Dr. Khan who has gone above and beyond to help my son calm down before he operated on him. Dr. Khan and his staff were so caring and attentive to all our needs that makes this surgery stand out from the rest. I will be forever eternally grateful to Dr. Khan.  Thank you!"

Thornhill Circumcision Centre, main theatre

Before Operation Preperation Room