Surgical therapy of penis carcinoma

Primary therapy of penile cancer (carcinoma in situ/T1 tumors) consists of circumcision, microsurgical excision, application of 5-fluorouracil cream, radiation, or laser treatment. In cases of larger T1 tumors or T2 and distal T3 tumors, partial penectomy with a 2-cm margin of clearance is mandatory. Secondary therapy includes inguinal lymphadenectomy 4-6 weeks after primary treatment and antibiotic prophylaxis. Independent prognostic factors for the presence of lymph node metastases are T stage and grading. Only patients with noninvasive G1 or G2 tumors and nonpalpable inguinal lymph nodes are candidates for surveillance with careful follow-up. Inguinal lymphadenectomy is performed in a radical or modified (Catalona) manner. Sentinel biopsy (Cabanas) may regain importance with the use of gamma probes. Complication rates of inguinal lymphadenectomy correlate to the extent of the procedure and must be weighed against the possibility of cure with lymphadenectomy. In cases of inguinal lymph node metastasis, removal of the iliac lymph nodes (one- or two-step procedure) is necessary.