Long-Term Follow-up of Mohs Surgery Shows Promise for Localized Penile Cancer

December 4, 2020
Kristie L. Kahl

The procedure provided effective, long-term local control for patients with localized penile cancer, highlighting the need for a multidisciplinary approach to patient care.

Mohs surgery may provide effective, long-term local control for patients with localized penile cancer, according to a 10-year retrospective study presented at the Society of Urologic Oncology (SUO) 21st Annual Meeting.

The procedure demonstrated overall survival (OS) of 97.7% and recurrence-free survival (RFS) of 93.0%.

“Penile carcinoma is a rare malignancy with an annual incidence of 0.1 to 0.7 per 100,000 men, accounting for fewer than 1% of male cancers in the United States. Treatment is associated with continual mutilation changes to the quality of life for these patients,” Nicolas E. Alcalá, a fourth-year medical student at the University of North Carolina, said during a virtual presentation. “Therefore, organ-sparing approaches have been on the rise.”

To maximize oncologic control and minimize psychologic emotional impacts of surgery, treatment for penile carcinoma include partial penectomy, local excision, topical chemotherapy, laser ablation, circumcision, glansectomy, and glans resurfacing.

However, Alcalá et al questioned whether Mohs microsurgery provided effective oncologic control and localized penile carcinoma. The researchers created REDCap database looking at patients from 2010 to 2020 with penile carcinoma at the University of North Carolina treated with Mohs microsurgery. Patients were seen in a multidisciplinary setting, including urologic oncology, dermatology, and reconstructive urology.

Patients with Ta, Tis, T1, and T2 disease were considered candidates for Mohs surgery.

Forty-three men who underwent Mohs surgery were identified using a prospectively maintained database. Clinical and pathologic data were collected for descriptive analysis.

In particular, the researchers evaluated variables including demographics, risk factors, lesion location, tumor size, grade, and stage. OS and RFS served as the primary outcomes.

Patients were a median age of 64 (range, 23-83), and the majority were white (88.4%). The main risk factors were patients who were not circumcised (23%) and those with a history of carcinoma in situ (23%).

Stage distribution was Ta in 4.7%, Tis in 58.1%, T1a in 14.0% %, T1b in 7.0%, and T2 in 16.3%. In total, 14% of patients reported with Grade 1 disease, 14% with Grade 2, 37.2% with Grade 3, and 34.9% with unknown grade disease. Lesions were predominantly located on the glans (41.9%).

No patient had a positive surgical margin after Mohs surgery. RFS was 93.0%, with 3 patients (7%) who experienced a recurrence. Of those with a recurrence, 2 patients exhibited local recurrence within 6 months, were treated with local resection, and found to be Tis, while 1 patient with T1b disease had a T1bN2 recurrence at 2 years and was treated with paclitaxel, ifosfamide, and cisplatin.

OS was 97.7%, with 1 death from non-cancer related causes.

“Mohs microsurgery provides effective local control for localized penile cancer. A multidisciplinary team involving urologic oncology, reconstructive oncology, and Mohs surgery is essential to patient management,” Alcalá concluded, adding that he and his colleagues will be finalizing outcomes looking at sexual, urinary, and overall health-related quality of life.

Reference:

Alcalá NE, Reines KL, Merritt B, Figler B, Bjurlin M. Oncologic Outcomes of Mohs Surgery for Localized Penile Carcinoma: A 10-Year Retrospective Study. Presented at: Society of Urologic Oncology 21st Annual Meeting; December 3, 2020. Abstract 7.