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Cortese BD, Chelluri R, Skokan AJ, Xia L, Ostrowski DA, Roberson DS, Schwartz L, Lee DJ, Lukowiak TM, Guzzo TJ, Malkowicz SB, Miller CJ, Kovell RC. Oncologic control and predictors of urologic reconstruction after Mohs micrographic surgery for low-risk penile malignancy. Int Urol Nephrol 2024:10.1007/s11255-024-04121-6. [PMID: 38922534 DOI: 10.1007/s11255-024-04121-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/10/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE Mohs micrographic surgery (MMS) is a low-risk penile cancer management option. However, contemporary patients' short-term oncologic control and preoperative characteristics predicting reconstruction needs are undefined. This study assesses MMS's oncologic efficacy for low-risk penile cancer and identifies baseline predictors of post-resection reconstruction referral. METHODS We retrospectively reviewed 73 adult males with 78 penile cutaneous malignancies treated with MMS from 2005 to 2019. Patients underwent MMS with or without surgical reconstruction. Demographic information, MMS operative details, lesion pathology, and short-term outcomes were recorded. Descriptive statistics for all variables were calculated, and logistic regression identified predictive factors for urologic referral for complex reconstruction. RESULTS Seventy-three men with 78 lesions, all staged ≤ cT1a prior to MMS, were identified. Twenty-one men were found to have invasive SCC. Median follow-up was 2.0 years (IQR 0.8-5.2 years). MMS was able to clear the disease in 90.4% of cases. One patient had disease related death following progression. Dermatology closed primarily in 68% of patients. Twenty percent of patients had a complication, most commonly poor wound healing. On univariate and multivariate linear regression analysis, lesion size > 3 cm and involvement of the glans independently predicted the need for referral to a reconstructive surgeon. CONCLUSIONS MMS for penile cancer appears to provide sound oncologic control in the properly selected patient. Involvement of a reconstructive surgeon may be needed for glandular and large lesions, necessitating early referral to a comprehensive multidisciplinary care team.
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Affiliation(s)
- Brian D Cortese
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Raju Chelluri
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | | | - Leilei Xia
- University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - David A Ostrowski
- Department of Surgery, Division of Urology, University of Pennsylvania Health System, 800 Walnut Street, Urology Offices, Philadelphia, PA, USA
| | - Daniel S Roberson
- Department of Surgery, Division of Urology, University of Pennsylvania Health System, 800 Walnut Street, Urology Offices, Philadelphia, PA, USA
| | - Lauren Schwartz
- Department of Pathology, University of Pennsylvania Health System, Philadelphia, PA, 19107, USA
| | - Daniel J Lee
- Department of Surgery, Division of Urology, University of Pennsylvania Health System, 800 Walnut Street, Urology Offices, Philadelphia, PA, USA
| | - Tess M Lukowiak
- Department of Dermatology, Rutgers Robert Wood Johnson, Somerset, NJ, USA
| | - Thomas J Guzzo
- Department of Surgery, Division of Urology, University of Pennsylvania Health System, 800 Walnut Street, Urology Offices, Philadelphia, PA, USA
| | - S Bruce Malkowicz
- Department of Surgery, Division of Urology, University of Pennsylvania Health System, 800 Walnut Street, Urology Offices, Philadelphia, PA, USA
| | - Christopher J Miller
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - R Caleb Kovell
- Department of Surgery, Division of Urology, University of Pennsylvania Health System, 800 Walnut Street, Urology Offices, Philadelphia, PA, USA.
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European Association of Urology-American Society of Clinical Oncology Collaborative Guideline on Penile Cancer: 2023 Update. Eur Urol 2023; 83:548-560. [PMID: 36906413 DOI: 10.1016/j.eururo.2023.02.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/25/2023] [Indexed: 03/11/2023]
Abstract
CONTEXT Penile cancer is a rare disease but has a significant impact on quality of life. Its incidence is increasing, so it is important to include new and relevant evidence in clinical practice guidelines. OBJECTIVE To provide a collaborative guideline that offers worldwide physician and patient guidance for the management of penile cancer. EVIDENCE ACQUISITION Comprehensive literature searches were performed for each section topic. In addition, three systematic reviews were conducted. Levels of evidence were assessed, and a strength rating for each recommendation was assigned according to the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology. EVIDENCE SYNTHESIS Penile cancer is a rare disease but its global incidence is increasing. Human papillomavirus (HPV) is the main risk factor for penile cancer and pathology should include an assessment of HPV status. The main aim of primary tumour treatment is complete tumour eradication, which has to be balanced against optimal organ preservation without compromising oncological control. Early detection and treatment of lymph node (LN) metastasis is the main determinant of survival. Surgical LN staging with sentinel node biopsy is recommended for patients with a high-risk (≥pT1b) tumour with cN0 status. While (inguinal) LN dissection remains the standard for node-positive disease, multimodal treatment is needed in patients with advanced disease. Owing to a lack of controlled trials and large series, the levels of evidence and grades of recommendation are low in comparison to those for more common diseases. CONCLUSIONS This collaborative penile cancer guideline provides updated information on the diagnosis and treatment of penile cancer for use in clinical practice. Organ-preserving surgery should be offered for treatment of the primary tumour when feasible. Adequate and timely LN management remains a challenge, especially in advanced disease stages. Referral to centres of expertise is recommended. PATIENT SUMMARY Penile cancer is a rare disease that significantly impacts quality of life. While the disease can be cured in most cases without lymph node involvement, management of advanced disease remains challenging. Many unmet needs and unanswered questions remain, underlining the importance of research collaborations and centralisation of penile cancer services.
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Current management and future perspectives of penile cancer: An updated review. Cancer Treat Rev 2020; 90:102087. [PMID: 32799062 DOI: 10.1016/j.ctrv.2020.102087] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 02/07/2023]
Abstract
Penile cancer (PeCa) is a rare disease worldwide, accounting for less than one percent of all malignancies in men. It usually presents as a painless ulcer or lump on the head of the penis. Squamous cell carcinoma represents the most common histological subtype of PeCa, with pathogenesis intimately linked to chronic Human Papilloma Virus (HPV) infection. Surgery is the cornerstone for the treatment of primary PeCa with potential mutilating outcome depending on the nodal extension of the disease. However, in case of extensive lymph node involvement, multidisciplinary treatment including perioperative chemotherapy and inclusion in clinical trial should be considered. To date, advanced or metastatic disease still have poor prognosis and are a therapeutic challenge with limited options, highlighting the need of new treatments and further investigations. Growing efforts to identify molecular alterations, understand the role of HPV and characterize immune contexture have expanded over the past years, providing further perspectives in prognostication, predictive biomarkers and therapeutic intervention. In this review, we provide an updated overview of current management of PeCa focusing on perioperative strategy. We discuss about new insights of the biology of PeCa and comment future directions in the field.
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Babbar P, Yerram N, Crane A, Sun D, Ericson K, Sun A, Khanna A, Wood H, Stephenson A, Angermeier K. Penile-sparing modalities in the management of low-stage penile cancer. Urol Ann 2018; 10:1-6. [PMID: 29416267 PMCID: PMC5791443 DOI: 10.4103/ua.ua_93_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Penile-sparing modalities are gaining widespread adoption for the management of low-stage penile cancer due to an increasing demonstration of sound oncologic, cosmetic, sexual, psychosocial, and quality of life outcomes. This review aims to provide a comprehensive overview of the respective treatment options in the armamentarium of the practicing urologist in dealing with this rare but problematic condition.
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Affiliation(s)
- Paurush Babbar
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Nitin Yerram
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Alice Crane
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Daniel Sun
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Kyle Ericson
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Andrew Sun
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Abhinav Khanna
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Hadley Wood
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Andrew Stephenson
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Kenneth Angermeier
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Beilan JA, Manimala NJ, Slongo J, Loeb A, Spiess PE, Carrion RE. Surgical Reconstruction After Penile Cancer Surgery. CURRENT SEXUAL HEALTH REPORTS 2017. [DOI: 10.1007/s11930-017-0134-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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