Penile Cyst Treatment
Complete surgical excision is the definitive treatment for penile cysts, with excellent outcomes and minimal recurrence when performed properly. 1, 2, 3, 4
Diagnostic Considerations Before Treatment
Before proceeding with treatment, you must differentiate benign cysts from malignant lesions:
- Epidermoid cysts present as slow-growing, well-demarcated, soft subcutaneous masses, typically asymptomatic 1, 2
- Median raphe cysts occur along the ventral midline from the urethral meatus to the anus, most commonly near the glans 3, 4
- Critical caveat: Ulcerated penile lesions can mimic cancer and require surgical exploration with intraoperative histological examination to exclude malignancy 1
Treatment Algorithm
For Confirmed Benign Cysts
Perform complete surgical excision with the following approach:
- Wide local excision of the entire cyst with adequate margins 1, 2
- Send all excised tissue for histopathological examination to confirm diagnosis and exclude neoplasia or squamous cell carcinoma 5
- Use intraoperative frozen section if there is any concern for malignancy 5
- Ensure meticulous hemostasis using diathermy/electrocautery or sutures as needed 6
Postoperative Management
- Apply topical steroids postoperatively if inflammatory changes or lichen sclerosus are present to prevent Koebner phenomenon and recurrence 5, 7
- Follow-up at 3 months to evaluate for residual disease 5
- Monitor for signs of infection: increased redness, warmth, purulent discharge, or fever 7
Alternative Management Options
Watchful observation may be considered only for:
- Small, asymptomatic cysts in children where the diagnosis is certain 2
- Patients who decline surgery and have confirmed benign pathology
Important caveat: There are no reports of malignancy developing in penile cystic disease, but any ulcerated or rapidly growing lesion requires immediate surgical exploration 1, 2
Common Pitfalls to Avoid
- Never assume an ulcerated penile lesion is benign - these can mimic cancer and require wide excision with intraoperative histology 1
- Do not perform incomplete excision - this leads to recurrence; the entire cyst wall must be removed 2
- Do not skip histopathological examination - even clinically benign-appearing lesions require pathologic confirmation 5, 1