title: Mohs micrographic surgery for penile cancer: management and long-term followup.
abstract: OBJECTIVE
  Mohs micrographic surgery is efficacious for the primary treatment and local recurrence control of nongenital and cutaneous squamous and basal cell cancers. The efficacy of this procedure for squamous cell carcinoma of the penis was reviewed.
  
  
  METHODS
  We retrospectively reviewed the charts of all patients treated with Mohs micrographic surgery for penile cancer at our institution from 1988 to 2006.
  
  
  RESULTS
  We identified 33 patients who underwent a total of 41 Mohs procedures. Average +/- SD lesion size was 509 +/- 699 mm(2). An average of 2.6 +/- 1.4 stages were done using Mohs micrographic surgery. Five procedures were terminated with positive margins, including 3 due to urethral involvement and 2 due to defect size. Of the tumors 26 were stage Tis, 4 were T1, 7 were T2 and 4 were T3. A total of 13 defects were reconstructed by primary repair or granulation, 4 were reconstructed by skin grafts and 25 were reconstructed by tissue flaps and urethroplasty. Followup data were available on 25 patients at a mean of 58 +/- 63 months. Eight patients (32%) had recurrence, which was managed by repeat Mohs micrographic surgery in 7 and by penectomy in 1. There were 2 cases of tumor progression, including 1 from T1 to T3 disease (meatal involvement) and 1 from T1 to inguinal lymph node involvement. Two patients died, of whom 1 had no evidence of penile cancer and 1 had metastatic disease.
  
  
  CONCLUSIONS
  Mohs micrographic surgery for low stage penile cancer results in a relatively high local recurrence rate. However, with repeat procedures and vigilant followup cancer specific and overall survival rates are excellent and progression rates are low.
authors.affiliation: Division of Urology, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri 63110, USA.
authors.forename: Alan W
authors.initials: AW
authors.lastname: Shindel
authors.forename: Margaret W
authors.initials: MW
authors.lastname: Mann
authors.forename: Ronan Y
authors.initials: RY
authors.lastname: Lev
authors.forename: Roberta
authors.initials: R
authors.lastname: Sengelmann
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Petersen
authors.forename: George J
authors.initials: GJ
authors.lastname: Hruza
authors.forename: Steven B
authors.initials: SB
authors.lastname: Brandes
mesh_terms: D001706:Biopsy; D002278:Carcinoma in Situ / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018289:Carcinoma, Verrucous / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D015580:Mohs Surgery / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology; D009367:Neoplasm Staging; D010412:Penile Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States