a 16-year - old male was referred with features of right hemi - hypertrophy and severe lymphoedema affecting his scrotum and penis .  
he had previously undergone scrotal reduction surgery at the age of 13 , but had since developed worsening penile oedema .
his main concern was that of cosmetic appearance prior to sexual debut , and he also complained of erectile dysfunction .
he did not perceive the penis becoming hard or erect , but was able to achieve orgasm and ejaculate . on examination , he had gross lymphoedema of the right leg , minor residual scrotal , and inguinal swelling , but severe chronic penile lymphoedema .
an mri confirmed gross oedema of the penile skin , but normal underlying cavernosal structure , and no other anatomical abnormality ( see figures 1 and 2 ) .   under general anaesthesia , the entire diseased penile skin was excised .
two full thickness skin grafts ( 4.5  cm  8.5  cm ) were harvested from the axillae , and grafted onto the dorsal and ventral penile shaft , respectively ( see figure 4 ) .
followup at 4 months confirmed complete graft take with minimal scarring , and the patient was very satisfised with the cosmetic outcome .
he had also noticed a recovery in erectile activity , and feels psychologically and physically more prepared for sexual relations   ( see figure 5 ) .
to our knowledge , penile lymphoedema secondary to proteus syndrome has not previously been reported . a case by clark et al . in 1987 reported on a 2-year - old boy with proteus syndrome , macro - orchidism , and penile hypertrophy without any other signs of virilisation .  
proteus syndrome is a hamartomatous disorder characterised by multiple focal overgrowths that can involve any structure of the body .  
it was named after the greek god of the sea , proteus , who was capable of assuming many forms to escape capture .
one aetiological hypothesis is somatic mosaicism , the presence of genetically distinct populations of somatic cells , that can be lethal in the nonmosaic state .
it was first described by cohen and hayden in 1979 as a disorder characterized by the overgrowth of various tissues , hyperostoses , epidermal nevi , and connective tissue nevi , where overgrowth is defined as asymmetry that is greater than normal .
surgical removal of the diseased skin and replacement with skin grafts is an effective means of restoring cosmetic appearance and functionality .
 to our knowledge penile lymphoedema secondary to proteus syndrome has not previously been reported . 
 hence we report a case of a 16-year - old male who was referred with features of right hemi - hypertrophy and severe lymphoedema affecting his scrotum and penis . 
 
 he had previously undergone scrotal reduction surgery at the age of 13 , but had since developed worsening penile oedema . 
 his main concern was that of 
 cosmetic appearance prior to sexual debut , and he also complained of erectile dysfunction . 
 an mri confirmed gross oedema of the penile skin , but normal underlying cavernosal structure , and no other anatomical abnormality . under general anaesthesia , the entire diseased penile skin was excised . 
 two full thickness skin grafts were harvested from the axillae , and grafted onto the dorsal and ventral penile shaft respectively . 
 a compressive dressing and urinary catheter was applied for 7 days . 
 follow - up at 4 months confirmed complete graft take with minimal scarring , and the patient was very satisfied with the cosmetic outcome . 
 he had also noticed a recovery in erectile activity , and feels psychologically and physically more prepared for sexual relations . 
1. Case Presentation
2. Discussion