Low recurrence, high satisfaction in male genital skin cancer treated with Mohs surgery

Local recurrence rates of male genital skin cancer were low for patients who underwent Mohs micrographic surgery, according to a study published in Journal of the American Academy of Dermatology.

“Surgical treatment for male genital skin cancer has traditionally been conventional excision for scrotal skin cancer and total or partial amputation for penile cancer,” Tess M. Lukowiak, BS, of Drexel University College of Medicine, and colleagues wrote.

Rates of positive margins and local recurrence are high in scrotal skin cancer, and while total or partial amputation for penile cancer has a low recurrence rate, it impairs sexual activity and function.

“Mohs micrographic surgery (MMS) is an organ-sparing technique that uses comprehensive microscopic margin evaluation to confirm complete tumor removal before reconstruction,” the authors wrote.

The retrospective case study included 108 patients with 119 skin cancers removed via MMS. Ninety tumors were on the penis and 29 on the scrotum.

Local recurrence, defined as a tumor arising within the MMS scar, occurred in one patient (0.84%). Regional nodal metastasis was detected in two patients (1.68%), and two patients developed inguinal nodal metastasis.

The study’s secondary outcomes evaluated patient-reported outcomes regarding sexual and urinary function and satisfaction with the surgery.

Satisfaction in surgery outcome was reported in 40 of 41 (97.56%) patients who responded to the survey, with the one patient who experienced local recurrence responding he was not satisfied.

Of the 41 patients who responded to the survey, 36 completed the entire survey, and 23 of 40 (57.5%) said they agreed or strongly agreed that sexual function had not changed with the surgery.

Urinary function was not significantly changed for 27 subjects (66%).

“Maintaining function is a priority for patients. More than a quarter of men with penile cancer would choose a treatment with lower long-term survival to increase the chance of remaining sexually potent,” the authors wrote. “MMS may be indicated for tumors that are currently not included in treatment guidelines. Developing consensus guidelines with clear indications for MMS may benefit more men with genital skin cancers.”