From the Guidelines
The treatment for squamous cell carcinoma (SCC) of the penile shaft should be guided by the stage and extent of the disease, with penile-preserving techniques preferred for early-stage disease, as recommended by the ESMO clinical practice guidelines 1.
Treatment Approach
The approach to treating SCC of the penile shaft varies based on the disease stage. For Tis or Ta lesions, penile-preserving techniques such as topical therapy (5% 5-fluorouracil and 5% imiquimod cream), circumcision, and wide local excision are recommended 1.
- Key considerations include:
- Disease stage: Tis, Ta, T1G1-2, T1G3-4, T ≥ 2
- Tumor size and location
- Presence of lymph node involvement
Early-Stage Disease
For early-stage, localized penile SCC (T1G1-2), penile-preserving techniques, including wide local excision plus reconstructive surgery, laser therapy, or radiotherapy, are preferred 1. These methods aim to preserve penile function while ensuring complete tumor removal.
Advanced Disease
In cases of more advanced disease (T1G3-4, T ≥ 2), with tumor invasion into the corpora cavernosa, partial or total penectomy may be necessary 1. The decision to perform penectomy depends on the extent of tumor invasion and the patient's overall health status.
Lymph Node Involvement
For patients with lymph node involvement, inguinal lymph node dissection (ILND) is often necessary, potentially followed by adjuvant chemotherapy 1. The management of lymph nodes is critical in preventing disease progression and improving survival outcomes.
Follow-Up
Regular follow-up is essential after treatment, typically every 3-6 months for the first two years, then every 6-12 months thereafter, to monitor for recurrence 1. Early detection of recurrence can significantly improve treatment outcomes.
From the Research
Treatment Options for SCC of Penile Shaft
- The treatment for squamous cell carcinoma (SCC) of the penile shaft can involve various surgical modalities, including Mohs micrographic surgery (MMS) and wide local excision (WLE) 2, 3.
- MMS has been shown to have superior outcomes for local recurrence compared to WLE, making it a reasonable option for managing anogenital SCC, including penile shaft SCC 2.
- WLE is also a common treatment option, but it may have higher local recurrence rates, especially for larger tumors or those with high-risk pathological features 4.
Factors Affecting Treatment Outcomes
- Several clinicopathological factors can influence the outcome of WLE, including older age at diagnosis, lesion location, previous treatment, increased lesion diameter, invasive subtype, and increased tumor thickness 4.
- The European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO), and the European Organization of Research and Treatment of Cancer (EORTC) recommend a standardized minimal margin of 5 mm for low-risk tumors and an extended margin of 10 mm for high-risk tumors 5.
Alternative Treatment Options
- Radiation therapy can be considered as a primary treatment for small SCCs in low-risk areas or as an adjuvant treatment after surgery 5.
- Chemotherapy, including epidermal growth factor receptor inhibitors, can be used to treat advanced or metastatic SCC, but there is no standard regimen 6, 5.
- Sentinel lymph node biopsy and lymph node dissection may be necessary for patients with high-risk tumors or lymph node involvement 5, 3.