In some chronic penile conditions, including balanoposthitis, phimosis and lichen sclerosus, an increase in cyclooxygenase 2 (COX2) expression drives the overproduction of prostaglandins 226, resulting in activation of EGFR, b-catenin, and PI3K, as key players in carcinogenesis. This evidence concerns the gene PTGS2 and lichen sclerosus et atrophicus.