Penile Cancer: The Daily PANCE Blueprint
A 65-year-old man presents with a 2-month history of a growing lesion on his penis. Physical examination reveals a 1.5 cm exophytic mass on the glans penis with irregular borders. Biopsy shows moderately differentiated squamous cell carcinoma invading the subepithelial connective tissue. There is no palpable inguinal lymphadenopathy. What is the most appropriate next step in management?
A. Topical imiquimod therapy
B. Wide local excision with negative margins
C. Total penectomy
D. Radiation therapy
E. Mohs micrographic surgery
Answer and topic summary
The answer is B. Wide local excision with negative margins
Explanation: This patient has a T1 penile squamous cell carcinoma based on the biopsy showing invasion into the subepithelial connective tissue. For T1 tumors, organ-preserving strategies are preferred when possible. Wide local excision with negative margins is an appropriate organ-preserving approach for this lesion, aiming to preserve penile form and function while achieving complete tumor removal.
Incorrect answers:
- A. Topical imiquimod therapy: This is primarily used for carcinoma in situ (Tis) lesions, not for invasive carcinoma as in this case.
- C. Total penectomy: This is overly aggressive for a T1 lesion. Penile amputation is typically reserved for bulky T2-T4 tumors or cases where organ-preserving approaches are not feasible.
- D. Radiation therapy: While radiation can be used for some T1-T2 lesions <4 cm, surgical excision is generally preferred for better local control and to avoid radiation-related complications.
- E. Mohs micrographic surgery: While sometimes used for Tis to T1 lesions, it is not as commonly employed as wide local excision for penile cancer and may not be available at all centers.
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