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Mohs micrographic surgery may be option to standard excision for penile SCC
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Mohs micrographic surgery for penile squamous cell carcinoma provided a high cure rate with tissue conservation that may be an alternative to other excision techniques, according to recently published study data.
Researchers conducted a retrospective review of 42 Caucasian patients (mean age at surgery, 64.4 years) with 44 penile squamous cell carcinomas (SCCs) treated with Mohs micrographic surgery (MMS).
“Although SCC of the penis is a rare malignancy, the disfigurement and psychological consequences of extensive surgery can be devastating for patients,” the researchers wrote. “Complete cancer eradication with maximal organ preservation is the primary goal of treatment.”
Thirty-nine percent of the tumors were located predominantly on the glans penis, 41% on the shaft, 14% on the base of the penis, and 4.5% on the prepuce. There were 48 cases of MMS performed, including 44 initial tumors and four post-Mohs surgery recurrences.
In 19 primary SCCs in situ, one recurrence occurred for a cure rate of 94.7%, with a mean follow-up of 97.4 months. The recurrent case, which occurred after 9 months, was treated with a second MMS procedure.
In 10 patients with primary invasive SCC with follow-up data, no recurrences were reported.
In six invasive SCCs that were previously treated with non-Mohs modalities, two recurred. The recurrences were treated with MMS, and there were no other recurrences reported, for a final cure rate of 100%.
Four patients had SCC in situ of the glans extending down the urethra. All required urethral dilation postoperatively secondary to urethral stricture, with none of the tumors recurring and normal function being restored.
“MMS is a tissue conservative, margin-controlled surgical excision technique that may benefit patients with penile carcinoma, especially considering that 80% of penile SCC occurs on the glans penis,” the researchers wrote. “Mohs micrographic surgery does not need to be limited to low-grade, small, superficial tumors as has been suggested, particularly if a multidisciplinary approach is utilized. [MMS] can be used for tumors with urethral involvement and may spare patients from partial or total penectomy.
“Although higher than expected with MMS for nongenital sites, our initial recurrence rate of 11.1% for MMS for penile SCC is lower than that for other treatment methods at this site.” – by Bruce Thiel
Disclosure: The researchers report no relevant financial disclosures.
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