The histological extent of the local spread of carcinoma of the penis and its therapeutic implications

Abstract

Objective To explore the possibility of reducing the margin of clearance at surgery for carcinoma of the penis without causing an increase in the incidence of local tumour recurrence, so that the functional and cosmetic compromise associated with penectomy might be minimized. Patients and methods Sixty-four patients underwent partial or total penectomy based on the extent of tumour. The specimens were evaluated histologically for grade and for proximal microscopic extensions beyond the grossly visible tumour margin, by examining serial proximal 5 mm sections. The histological grade of the lesion was correlated with its clinical site, morphology and proximal microscopic spread. Differences were assessed using the chi-squared test.Results Of 64 tumours, 31% were grade 1, 50% grade 2 and the remaining 19% grade 3. Higher grade lesions were more likely to involve the penile shaft. The maximum proximal histological extent was 5 mm for grades 1 and 2, and 10 mm for grade 3 tumours; there was no discontinuous spread. Conclusions Histological grading is mandatory in the management of carcinoma of the penis. A 10-mm clearance is adequate for grade 1 and 2 lesions, and 15 mm for grade 3 tumours. This approach would qualify more patients for partial rather than total amputation; the residual length of the penis would then be cosmetically and functionally more acceptable.

Organ-sparing reconstructive surgery in penile cancer: initial experiences at two Swedish referral centres

“…The traditional 2 cm excision margin has been questioned, and a margin of only a few millimetres is now considered sufficient in selected cases [11][12][13][14]. Negative surgical margins are the "gold standard" in the treatment of penile cancer, although the width of the negative surgical margin does not seem to be an independent prognostic marker [14].…”

Surgical treatment of primary disease for penile squamous cell carcinoma: A Surveillance, Epidemiology, and End Results database analysis

“…As the average length of the glans is ~4 cm (26), local excision of tumors with a size >3 cm may result in a tumor-free margin of <1 cm. Agrawal et al (4) observed an absence of grade 1-2 penile SCC that extended 1 cm beyond the gross tumor margin; however, 25% of grade 3 lesions were histologically positive at 1 cm (4). In these patients with larger tumors, glansectomy with reconstruction is a better alternative to achieve satisfactory oncological and functional outcomes (27).…”

Glansectomy with split-thickness skin graft for the treatment of penile carcinoma

“…5,9,10-12 Indeed, many reports have shown similar 5-year disease-specific survival rates, reducing the width of the resection margins to 10 and 15 mm for grade 1-2 and 3 lesions, respectively. 9,11,13,14 If tumor recurrence occurs, it is usually systemic at the inguinal lymph nodes. In our series of patients treated with total glansectomy, only one patient had inguinal lymph node metastases 18 months after surgery, whereas none had local relapse, and our crude disease-specific survival rate of 93.3% after a mean follow-up of 36 months is similar to that reported by others using conventional surgical treatment.…”