Elsevier

Urology

Volume 52, Issue 4, October 1998, Pages 559-565
Urology

Rapid Communications
Laser therapy of squamous cell dysplasia and carcinoma of the penis

https://doi.org/10.1016/S0090-4295(98)00308-2Get rights and content

Abstract

Objectives. To analyze the influence of etiologic factors and practical issues regarding the merits, limitations, and long-term results of aggressive laser treatment of premalignant and malignant squamous cell lesions of the penis.

Methods. Preparation of genital skin with 5% acetic acid and mapping biopsies of lesions and the surrounding field-of-change were performed in 52 men evaluated and subsequently treated with laser during a 10-year period. Most men (81%) were or had been smokers, and many (46%) had female sexual partners infected with human papillomavirus. Carbon dioxide laser was used for low-stage lesions; potassium-titanyl-phosphate/532 or neodymium:yttrium-aluminum-garnet laser was used for more histologically advanced lesions. Not only the lesions but also the entire human papillomavirus-induced field-of-change was treated. Circumcision was performed simultaneously in 28 previously uncircumcised patients.

Results. All lesions demonstrated aceto-whitening and histologic changes of human papillomavirus infection. Human papillomavirus DNA was detected in 93.5% of the specimens from 31 patients studied. Of the 52 patients, 22 (42%) had dysplastic premalignant penile intraepithelial neoplasia, and the remaining 30 (58%) had squamous cell carcinoma. Forty-four patients were available for follow-up from 12 to 117 months (average 58). Overall, 5 patients (11.4%) experienced a recurrence: 3 were successfully re-treated with laser, and 2 patients underwent partial penectomy, 1 of whom with squamous cell carcinoma Stage T2 died of metastatic disease.

Conclusions. Aggressive laser therapy of the visible lesions and of the entire dysplastic premalignant field-of-change produces excellent cosmetic results. The entire penis and, therefore, its full sexual functional potential are preserved. The low rate of local recurrence over the long term in all but deeply invasive (T2) lesions compares favorably with the outcome of other, more conventional therapies. Irrespective of therapeutic approach, close and long-term surveillance of all patients and counseling for their sexual partners are mandatory.

Section snippets

Material and methods

During a 10-year period (1987 to 1997), 52 men with premalignant or malignant squamous cell lesions of the penis whose ages ranged from 20 to 86 years (mean 51.6) were seen by one of us for evaluation and subsequently underwent laser treatment. Thirty-eight patients (73%) presented because they had noted a penile lesion, 10 (19%) were referred by gynecologists because of concern of human papillomavirus (HPV)-related problems in the patients’ female sexual partners, and 4 (8%) were seen for both

Results

Histologic evidence of HPV-related changes in association with PENIN, in situ, or invasive SCC involved only the contents of the preputial cavity. Other parts of the genital skin, when involved by subclinical aceto-white lesions, manifested only histologic changes related to HPV infection without dysplasia. Twenty-two patients (42%) had PENIN, 13 (25%) had in situ SCC (Tis), 16 (31%) had superficially invasive (into lamina propria) SCC (T1), and 1 (2%) had deeply invasive (into corpus

Comment

Despite the relative rarity of SCC of the penis in the United States (it represents less than 1% of all malignancies in men) and in other developed countries, it is one of the most common, if not the most common, genitourinary cancers in many developing countries.2, 21 Indeed, in Puerto Rico, it has represented almost 20% of all cancers in male patients.22 Reportedly, it can affect men from 20 to 90 years of age (mean age at diagnosis near the 6th decade, as noted in our series), and, because

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