Conservative surgery for the treatment of penile carcinoma

The rationale for organ preserving surgery in the treatment of squamous cell carcinoma (SCCA) of the penis is based on three key concepts. 1. About 80% of penile carcinomas occur distally, involving the glans and/or prepuce and thus are potentially amenable to organ preserving surgery. 2. Patients with penile carcinomas stages Tis, Ta, T1; grades 1 and 2 are at low risk for local progression and/or distant metastatic spread. 3. The traditional 2 cm excision margin has been challenged as unnecessary for patients undergoing partial penectomy for SCCA. Conservative techniques with surgical margins of less than 10 mm appear to offer excellent oncological control. Circumcision, laser ablation, Mohs’ micrographic surgery and partial or total glansectomy associated with various forms of reconstruction have been reported as surgical organ-preserving procedures for the treatment of SCCA. The aim of the present article is to give an overview on the results and indications of penile sparing surgical techniques in the treatment of penile cancer. For carcinoma in situ (also referred to as erythroplasia of Queyrat or Bowen’s disease) laser ablation has been employed successfully. In case of lesions limited to the foreskin, wide local excision with circumcision is sufficient primary curative therapy, although care must be taken to ensure adequate clearance margins are achieved. If the tumor has involved the glans, the choice of therapy is dictated by tumor size, extent of infiltration, and degree of tumor destruction of normal tissue. All these factors can indicate if organ preservation is a reasonable alternative to amputative procedures. Total and partial glansectomy, with or without grafting procedure, produce good cosmetic and functional results with minimal morbidity without sacrificing cancer control.