Penile cancer treated by Mohs micrographic surgery

Penis neoplasia is unusual in the United States and Europe while in developing countries there is a dramatic increase. In Brazil, the incidence is around 8.3 cases per 100,000 inhabitants.

Considering pathology profile, squamous cell carcinoma is the most prevalent, corresponding to 90–95% of all cases and the highest incidence occurs in the fifth and sixth decade of life. However, there is significant occurrence in patients under 50 years of age.

Major risk factors are phimosis, smoking, lack of hygiene, high number of sexual partners, and infection with the Human Papilloma Virus (HPV). The tumor injuries manifested through small areas of
hardening, erythema, ulcerations or infiltrative lesions.

Biopsy is crucial to confirm suspicion and, when treated in the early stages, has a survival rate of 60–80% over five years. The gold standard treatment is partial or total penectomy. Classically, the free margins considered safe for resection were 2 cm. However, the European Society of Urology (E.U.A.) suggests reducing the lateral margins to 5 mm and 1 mm in depth.

This change enabled the development of organ preserving techniques, among them the micrographic surgery of Mohs. The best indication is in situ or small, low-grade invasive neoplasia. The greatest benefit is the complete visualization of the injury removal, with negative margins, optimized aesthetic and functional results.

It follows the report of a young patient with a penile cancer whose conduct was Mohs’ microsurgery. We will discuss oncologic and functional aspects related to this therapeutic approach

Case presentation
A 32-year-old male patient, sexually active, presented with an ulcerated glandar lesion with several months of evolution, without improvement using topical corticoids self-medicated.

On clinical examination, five lesions in the glans were visualized, smaller than 2 cm, with raised edges and clean bottom (Fig. 1). Palpation of the inguinal regions was negative for lymphadenomegaly. The biopsy of the injury confirmed squamous cell cancer.

Micrographic surgery by Mohs was suggested and the procedure was performed in 2016, uneventfully and with closure of the cruciate region through flap rotation. The anatomopathology confirmed low grade cancer.

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