Society of Urologic Oncology (SUO) 21st Annual Meeting

SUO 2020: Oncologic Outcomes of Mohs Surgery for Localized Penile Carcinoma: A 10-Year Retrospective Study

( Penile cancer is a rare malignancy with an annual incidence of 0.1-0.7 in 100,000 men, which accounts for fewer than 1% of male cancers in the United States. Treatment is often associated with considerable mutilation and changes to quality of life. Organ sparing surgery for the management of localized penile cancer has the potential to maintain penile form and function while achieving equivalent oncologic control as partial or total penectomy. Furthermore, Mohs surgery is efficacious for the treatment of non-genital and cutaneous cancers first pioneered by Dr. Mohs for penile carcinoma in 1992 with a 5-year control rate of 94%. Although it is endorsed by the National Comprehensive Cancer Network (NCCN) guidelines for low-stage penile cancer management, there is a paucity of data on cancer outcomes in localized penile cancer. At the 2020 virtual annual meeting, 4th-year medical student Nicolas Alcala presented institutional work assessing oncologic outcomes in patients with localized penile carcinoma managed with Mohs surgery.

For this study, all patients from 2010 to 2020 with penile carcinoma at the University of North Carolina 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. Patients undergoing Mohs surgery (performed by a dermatologist under urologic guidance) were identified using a prospectively maintained database and clinical and pathologic data were collected for descriptive analysis. Variables included: lesion location, tumor grade, stage, overall survival, and recurrence-free survival (RFS).

There were 43 patients that met inclusion criteria with the following T stage:

penile cancer inclusion criteria

Mean age at diagnosis was 61.4 years and the complete baseline characteristics are summarized in the table:

mean diagnosis of penile cancer

Grade distribution was 14% Grade 1 (n=6), 14% (n=6) Grade 2, 37.2% Grade 3-4 (n=16), and 34.9% unknown (n=15). Lesions were predominantly located on the glans (41.9%). No patients had a positive surgical margin after Mohs. Among these patients, 46.5% (n=20) received combined reconstructive urologic repair following Mohs resection. For patients with Tis disease, the median follow-up was 56 months (IQR 14-83), and for ≥ Ta disease median follow-up was 17.5 months (IQR 10.5-51.8). RFS was 93.0% with three patients (7%) recurring, including two (66%) patients (one with T2, one with Tis) who exhibited local recurrence within six months, were treated with local resection and found to be Tis. One patient with T1b disease had T1bN2 recurrence at two years that was treated with TIP chemotherapy. Overall survival was 97.7%, with one death from non-cancer-related causes.

Alcala concluded his presentation with the following take-home messages:

  • Mohs surgery in appropriately selected provides effective long-term local control for localized penile cancer with an overall survival of 97.7% and an RFS of 93.0%
  • Future studies are needed to assess benefits in functional outcomes among men treated with Mohs surgery
  • A multi-disciplinary team involving urologic oncology, reconstructive urology, and Mohs surgery is essential to patient management

Presented by: Nicolas E. Alcalá, University of North Carolina, Chapell Hill, North Carolina

Written by: Zachary Klaassen, MD, MSc, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, Augusta, Georgia, Twitter: @zklaassen_md at the 2020 Society of Urologic Oncology Annual Meeting – December 2-5, 2020 – Washington, DC

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