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Excision of Penile Squamous Cell Carcinoma Is Associated With High Rates of Positive Surgical Margins
Shayan Cheraghlou1, Vartan Pahalyants, Neil K Jairath
1All authors are affiliated with the Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York.
Background:
Penile cancer is a rare malignancy, the most common subtype of which is squamous cell carcinoma (SCC). Organ-sparing surgery (OSS) is the first-line treatment for early-stage tumors given the quality-of-life impairments of penectomy. However, the rarity of penile SCC has made the large-scale study of the efficacy of surgical approaches difficult.
Objective:
To evaluate the rates of positive margins with the surgical approaches for penile SCC.
Methods:
Retrospective cohort study of adult patients with excised penile SCC from the National Cancer Database diagnosed from 2004 to 2019.
Results:
We found that treatment of penile SCC with OSS resulted in a positive margin rate of 18.8% (SE: 0.7%) versus 9.7% (SE: 0.4%) with partial penectomy and was associated with twice the odds of a positive margin compared with partial penectomy (odds ratio 2.312; p < .001). Positive margins were associated with poorer overall survival on multivariable analysis (hazard ratio 1.528; p < .01).
Conclusion:
OSS for penile SCC results in high rates of positive margins, which are associated with poorer overall survival. Use of margin-controlled surgery may improve local control for these tumors while minimizing functional damage to an anatomically sensitive organ, allowing for the most optimal quality-of-life outcomes.
