High survival rate after Mohs micrographic surgery for penile cancer
Original article
Shindel AW et al. (2007) Mohs micrographic surgery for penile cancer: management and long-term followup. J Urol 178: 1980–1985 PubMed
Mohs micrographic surgery (MMS) for dermatological cancers involves sequential tissue excision under microscopic control, with review of sections by the surgeon to ensure negative margins. The last case series reported of MMS for penile cancer was published in 1987; therefore, to provide a contemporary report, Shindel et al. reviewed their experience of penile cancer treatment with the technique.
The researchers identified 33 patients treated with MMS (41 procedures in total) for penile cancer at Washington University School of Medicine from 1988–2006. Five procedures were terminated because of urethral involvement or lesion size. The mean number of surgical stages was 2.6 
1.4, and the mean postoperative defect size was 3.6 
3.0 cm. Primary repair or granulation was used to correct 13 defects, 4 were repaired by skin grafts and 25 were repaired with tissue flaps and urethroplasty. Follow-up data for 25 patients were available; mean follow-up was 58 63 months. Cancer recurred in eight patients; seven underwent repeat MMS and one underwent penectomy. Tumor size did not seem to influence recurrence. Two patients died; one had metastatic cancer, the other had no evidence of recurrence at time of death. Recurrence-free survival was 68%, overall survival was 92% and disease-specific survival was 96%.
The authors conclude that, although local recurrence rates are high, MMS permits tumor removal with an improved functional and cosmetic result compared with penectomy. Survival rates are high, taking into account the need for close surveillance and the possibility of repeat procedures.
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Subject areas under which this article appears: Urologic oncology (nonprostatic)