Mohs Micrographic Surgery for Penile Squamous Cell Carcinoma: A Systematic Review

Area of Science:

• Oncology
• Dermatology
• Urology

Background:

• Penile squamous cell carcinoma (SCC) is often treated with penectomy, leading to significant psychosocial distress and disfigurement.
• Mohs micrographic surgery (MMS) is a tissue-sparing alternative, but its efficacy for penile SCC requires further investigation.
• Current guidelines recommend MMS for limited penile SCC stages (Tis/T1) due to insufficient data on recurrence rates.

Purpose of the Study:

• To systematically review clinical studies on Mohs micrographic surgery (MMS) for penile squamous cell carcinoma (SCC).
• To summarize disease outcomes, including recurrence and metastasis, following MMS for penile SCC.
• To document surgical complications associated with MMS in treating penile SCC.

Main Methods:

• A comprehensive systematic review of medical literature was performed.
• Databases searched included Ovid MEDLINE, Embase, Cochrane, CINAHL, and Web of Science.
• Studies published up to October 23, 2024, were included in the analysis.

Main Results:

• Nineteen studies involving 329 penile SCC cases were analyzed.
• Low rates of local recurrence (5%), nodal metastasis (3%), distant metastasis (0.3%), and disease-specific death (1%) were observed.
• Complications occurred in 9% of cases, with poor wound healing and urethral stricture being most common (3% each). Advanced-stage tumors showed higher local recurrence rates.

Conclusions:

• Mohs micrographic surgery (MMS) is an effective penis-sparing treatment for low-stage penile squamous cell carcinoma (SCC) with low recurrence.
• Multidisciplinary collaboration with urology is crucial for advanced-stage tumors, anticipated reconstruction, or urethral involvement.
• Further research is warranted due to the low level of evidence in the reviewed studies.