title: The histological extent of the local spread of carcinoma of the penis and its therapeutic implications.
abstract: OBJECTIVE
  To explore the possibility of reducing the margin of clearance at surgery for carcinoma of the penis without causing an increase in the incidence of local tumour recurrence, so that the functional and cosmetic compromise associated with penectomy might be minimized.
  
  
  METHODS
  Sixty-four patients underwent partial or total penectomy based on the extent of tumour. The specimens were evaluated histologically for grade and for proximal microscopic extensions beyond the grossly visible tumour margin, by examining serial proximal 5 mm sections. The histological grade of the lesion was correlated with its clinical site, morphology and proximal microscopic spread. Differences were assessed using the chi-squared test.
  
  
  RESULTS
  Of 64 tumours, 31% were grade 1, 50% grade 2 and the remaining 19% grade 3. Higher grade lesions were more likely to involve the penile shaft. The maximum proximal histological extent was 5 mm for grades 1 and 2, and 10 mm for grade 3 tumours; there was no discontinuous spread.
  
  
  CONCLUSIONS
  Histological grading is mandatory in the management of carcinoma of the penis. A 10-mm clearance is adequate for grade 1 and 2 lesions, and 15 mm for grade 3 tumours. This approach would qualify more patients for partial rather than total amputation; the residual length of the penis would then be cosmetically and functionally more acceptable.
authors.affiliation: Departments of Surgery and Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
authors.forename: A
authors.initials: A
authors.lastname: Agrawal
authors.forename: D
authors.initials: D
authors.lastname: Pai
authors.forename: N
authors.initials: N
authors.lastname: Ananthakrishnan
authors.forename: S R
authors.initials: SR
authors.lastname: Smile
authors.forename: C
authors.initials: C
authors.lastname: Ratnakar
mesh_terms: D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010412:Penile Neoplasms / Q000473:pathology* / Q000601:surgery; D010413:Penis / Q000473:pathology; D011446:Prospective Studies; D013518:Surgery, Plastic / Q000379:methods