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Introduction: Penile cancer is a rare disease with limited data regarding its management. Penile sparing and Mohs surgery are attractive options for patients with superficially invasive and non-invasive disease.
Methods: We conducted a retrospective analysis of all patients who presented to the urology department with a primary ICD-9 diagnosis of malignant neoplasm of the penis (187.4), glans penis (187.2), genital (187.9), and penis body (187.3) between 1996 and 2014. We also evaluated all patients who presented to the dermatology department and underwent Mohs surgery of the penis between 2005 and 2014.
Results: A total of 36 urology and 37 dermatology patients were available for analysis. For the urology patients, 26.5% underwent partial penectomy, 29.4% excision of lesion, 17.6% circumcision, and 20.6% biopsy with laser. Forty-four percent of patients required a lymph node dissection with 57.1% of these patients positive for metastasis. Local recurrence was 32.4%. Median follow up was 25.4 months. Local recurrence for Mohs patients was 5% although median follow up was only 5.2 months. For carcinoma in-situ (CIS), Mohs was associated with a significantly lower rate of local recurrence (p=0.001). When comparing the urology patients that recurred against those that did not, more aggressive surgery (partial penectomy or radical penectomy) was associated with a lower recurrence rate (p=0.005).
Conclusion: Penile cancer is a rare disease with various techniques for local control. Mohs surgery is a viable option for CIS or superficially invasive disease. When choosing alternative methods for removal, aggressive surgery is associated with lower recurrence rates.