Bandieramonte G et al. (2008) Peniscopically controlled CO2 laser excision for conservative treatment of in situ and T1 penile carcinoma: report on 224 patients. Eur Urol [doi:10.1016/j.eururo.2008.01.019]

Penile carcinoma is a rare tumor, traditionally treated by amputation 2 cm proximal to the tumor. A new study by an Italian group has shown that men with early-stage penile carcinoma can be effectively treated with a conservative, organ-sparing strategy—microscopic tumor classification followed by CO2 laser excision.

This retrospective, single-institution study included 224 patients with early-stage penile carcinoma treated with CO2 laser excision between 1982 and 2006. Patients initially underwent penile microscopy; tumors were classified by their appearance on exposure to 5% acetic acid. Patients with red or grayish white, acetoreactive, macular lesions (superficial carcinomas) underwent laser excisional biopsy for tumors <20 mm and incisional biopsy for larger tumors, followed by laser excision (and possibly circumcision); patients with cupuliform or exophytic lesions (in situ or invasive cancer) underwent incisional biopsy, reductive systemic chemotherapy, and laser microsurgery.

In total, 111 patients underwent partial surface excision and 113 underwent total surface excision. Reductive chemotherapy was administered to 44 patients. Concordance between the first and final histologic diagnoses was 77%. Tumors recurred in 32 patients and the 10-year recurrence rate was 17.5%. Nine patients required amputations, a median of 55 months after surgery. No intraoperative complications occurred, no patients complained of changes in erection capability, and cosmetic outcome was judged as satisfactory or excellent by all patients. The authors recommend penile microscopy to identify patients with early-stage penile carcinoma who have indications for conservative laser excision.