Oncologic control and predictors of urologic reconstruction after Mohs micrographic surgery for low-risk penile malignancy.

PURPOSE: Mohs micrographic surgery (MMS) is a low-risk penile cancer management option. However, contemporary patients' short-term oncologic control and preoperative characteristics predicting reconstruction needs are undefined. This study assesses MMS's oncologic efficacy for low-risk penile cancer and identifies baseline predictors of post-resection reconstruction referral. METHODS: We retrospectively reviewed 73 adult males with 78 penile cutaneous malignancies treated with MMS from 2005 to 2019. Patients underwent MMS with or without surgical reconstruction. Demographic information, MMS operative details, lesion pathology, and short-term outcomes were recorded. Descriptive statistics for all variables were calculated, and logistic regression identified predictive factors for urologic referral for complex reconstruction. RESULTS: Seventy-three men with 78 lesions, all staged ≤ cT1a prior to MMS, were identified. Twenty-one men were found to have invasive SCC. Median follow-up was 2.0 years (IQR 0.8-5.2 years). MMS was able to clear the disease in 90.4% of cases. One patient had disease related death following progression. Dermatology closed primarily in 68% of patients. Twenty percent of patients had a complication, most commonly poor wound healing. On univariate and multivariate linear regression analysis, lesion size > 3 cm and involvement of the glans independently predicted the need for referral to a reconstructive surgeon. CONCLUSIONS: MMS for penile cancer appears to provide sound oncologic control in the properly selected patient. Involvement of a reconstructive surgeon may be needed for glandular and large lesions, necessitating early referral to a comprehensive multidisciplinary care team.

Cyclin D1 expression in penile cancer.

The main goal of the present study was to analyze the expression profile of cyclin D1 in patients with PC, and to determine possible correlations with clinical and histopathological features. A survey was conducted with 100 patients diagnosed with PC, who were treated at two reference hospitals in São Luís, Maranhão, Brazil, between 2013 and 2017. A review of clinical, epidemiological, and histopathological data was performed, Human Papillomavírus (HPV) DNA was detected using polymerase chain reaction (PCR) and cyclin D1 expression analysis was performed using immunohistochemical techniques. The data revealed that the absence of cyclin D1 expression was significantly associated with HPV-positive histological subtypes (p = 0.001), while its expression was associated with high-grade tumors (p = 0.014), histological subtype (p = 0.001), presence of sarcomatoid transformation (p = 0.04), and perineural invasion (p = 0.023). Patients with cyclin D1 expression exhibited lower disease-free survival compared to the cyclin D1-negative group, although the difference was not statistically significant. The results suggest that cyclin D1 may be a potential biomarker for PC, especially for poorer prognosis.

Preoperative Albumin-to-Alkaline Phosphatase Ratio as an Independent Predictor of Lymph Node Involvement in Penile Cancer.

Background and Objectives: To investigate the role of preoperative albumin-to-alkaline phosphatase ratio (AAPR) in predicting pathologic node-positive (pN+) disease in penile cancer (PC) patients undergoing inguinal lymph node dissection (ILND). Materials and Methods: Clinical data of patients with squamous cell carcinoma (SCC) PC + ILND at a single high-volume institution between 2016 and 2021 were collected and retrospectively analyzed. An AAPR was obtained from preoperative blood analyses performed within 30 days from their scheduled surgery. A ROC curve analysis was used to assess AAPR cutoff, in addition to the Youden Index. Logistic regression analysis was utilized for an odds ratio (OR), 95% confidence interval (CI) calculations, and an estimate of pN+ disease. A p value < 0.05 was considered to be as statistically significant. Results: Overall, 42 PC patients were included in the study, with a mean age of 63.6 ± 12.9 years. The AAPR cut-off point value was determined to be 0.53. The ROC curve analysis reported an AUC of 0.698. On multivariable logistic regression analysis lymphovascular invasion (OR = 5.38; 95% CI: 1.47-9.93, p = 0.022), clinical node-positive disease (OR = 13.68; 95% CI: 4.37-43.90, p < 0.009), and albumin-to-alkaline phosphatase ratio ≤ 0.53 (OR = 3.61; 95% CI: 1.23-12.71, p = 0.032) were predictors of pN+ involvement. Conclusions: Preoperative AAPR may be a potentially valuable prognostic marker of pN+ disease in patients who underwent surgery for PC.

Human papillomavirus prevalence and genotype distribution in Liaocheng men between 2016 and 2022.

Human papillomavirus (HPV) infection can lead to HPV-related cancer in men, including the anus, penile, and oropharyngeal cancers and precancerous lesions. This study retrospectively investigated HPV prevalence and genotype distribution in Liaocheng men between 2016 and 2022. The total HPV positive rate was 64.87% (2388/3681, 95% confidence interval [CI]: 63.32%-66.40%), where high risk (HR)-HPV and low risk (LR)-HPV accounted for 42.49% (1564/3681, 95% CI: 40.90%-44.09%) and 69.71% (2566/3681, 95% CI: 68.20%-71.17%), respectively. The mixed HPV infection rate of two and more genotypes was 35.72%. The infection rate of HR-HPV increased with the number of positive cases annually from 2016 (16.91%) to 2022 (46.59%). The most common HR-HPV genotypes were HPV16 (11.60%), HPV52 (6.95%), and HPV59 (6.28%), whereas the least common HR-HPV was HPV26. The most common LR-HPV genotypes were HPV6 (56.99%), HPV11 (23.79%), and HPV43 (6.37%). The 9 v HPV vaccine preventable for LR-HPV and HR-HPV accounted for 80.78% and 30.40%, respectively, in this study. Most HPV-positive patients aged 1-86 were in the 30-39 age group. This study confirmed that HPV prevalence in Liaocheng men was common and diverse. HPV16, HPV52, and HPV59 are widely distributed in Liaocheng men, and the male HR-HPV infection rate remained high in this region. Regarding public health and cancer prevention, it is recommended and effective to include the HPV vaccination in the national vaccination program for men.

Twenty-two-year incidence trend of urological cancers in the Republic of Korea: 1999-2020.

PURPOSE: Cancer is a disease with high social costs, and policymaking through accurate statistics is very important. This study presents the national cancer statistics on the incidence of urological cancers in the Republic of Korea over 22 years, from 1999 to 2020. MATERIALS AND METHODS: Through the Korean Statistical Information Service, data on the incidence of urological cancers by sex and age in each year was obtained. For each urological cancer, the number of cases, crude incidence rate (CIR), and age-standardized incidence rate (ASR) were calculated, and the statistical trends were confirmed by joinpoint regression analysis. RESULTS: Urological cancers, which have increased ASR over 22 years, are as follows: prostate cancer (average annual percent change [AAPC]=6.72%, p-trend<0.05), testicular cancer (AAPC=5.26%, p-trend<0.05), ureter cancer (AAPC=4.16%, p-trend<0.05), kidney cancer (AAPC=4.14%, p-trend<0.05), renal pelvis cancer (AAPC=3.86%, p-trend<0.05), and total urological cancer (AAPC=4.37%, p-trend<0.05). Urological cancers, which has decreased ASR over 22 years, are as follows: penile cancer (AAPC=-2.93%, p-trend<0.05) and bladder cancer (AAPC=-0.31%, p-trend<0.05). CONCLUSIONS: It was confirmed that the ASR of all urological cancers increased for 22 years, except for bladder and penile cancer. With the aging of the population, the CIR increased for all urological cancers. This study will serve as basic data for future research and policy decisions.

Surveillance or Dynamic Sentinel Lymph-Node Biopsy in Low-Risk Clinically N0 Penile Squamous Cell Carcinoma: Single-Institution Real World Data.

INTRODUCTION: Surveillance is the standard management in low-risk cN0 penile squamous cell carcinoma (peSCC) patients. However, no previous analysis focused on early and long-term outcomes of these patients. We report on main oncological outcomes of a large series of low-risk cN0 peSCC patients. PATIENTS AND METHODS: Between 1980 and 2017 included, 93 evaluable consecutive low-risk (ie, pT1a G1 cN0M0) peSCC patients underwent primary tumor surgery and either observation (74) or dynamic sentinel node biopsy (DSNB) (19) following a clinical diagnosis of T1 in 66 (71%), T2 in 15 (16.1%) and Tx in 12 (12.9%) patients, respectively. The statistical significance of differences in medians and proportions was tested with the Kruskal-Wallis and chi-square tests. Kaplan-Meier plots illustrated 5-year inguinal relapse (IR)-free survival rates. RESULTS: Median age was 60 years (IQR: 50-69 years). Median follow-up was 92 months (IQR 54-133 months). Surveillance was more frequently adopted in clinical (c)T1 than in cT2 tumors (79.7% vs. 36.8%). None of 19 patients who had DSNB had nodal metastasis. Overall, 7 (7.5%) out of 93 pT1aG1cN0 peSCC patients had IR after a median interval of 9 months. Of note, 1 patient only relapsed after 12 months of surveillance. After stratification according to IR, relapses occurred more frequently in younger patients (59 vs. 64 years, P < .001). The 5-year IR-free survival rates for the entire cohort was 92% (95% Confidence interval [CI] 87-98%). CONCLUSIONS: Observation is a safe and effective management for low-risk peSCC patients. Younger patients may be offered a mini-invasive staging as an alternative.

Total Margin Control Is Superior to Traditional Margin Assessment for Treatment of Low-Stage Penile Squamous Cell Carcinoma.

PURPOSE: Penile cancer is rare, with significant morbidity and limited literature assessing utility of peripheral and deep en face margin assessment (PDEMA) vs traditional margin assessment (vertical sections) on treatment outcomes. MATERIALS AND METHODS: This was a 32-year retrospective multicenter cohort study at 3 academic tertiary care centers. The cohort consisted of 189 patients with histologic diagnosis of in situ or T1a cutaneous squamous cell carcinoma of the penis at Brigham and Women's, Massachusetts General Hospital (1988-2020), and Memorial Sloan Kettering Cancer Center (1995-2020) treated with PDEMA surgical excision, excision/circumcision, or penectomy/glansectomy. Local recurrence, metastasis, and disease-specific death were assessed via multivariable Cox proportional hazard models. RESULTS: The cohort consisted of 189 patients. Median age at diagnosis was 62 years. Median tumor diameter was 1.3 cm. The following outcomes of interest occurred: 30 local recurrences, 13 metastases, and 5 disease-specific deaths. Primary tumors were excised with PDEMA (N = 30), excision/circumcision (N = 110), or penectomy/glansectomy (N = 49). Of patients treated with traditional margin assessment (non-PDEMA), 12% had narrow or positive margins. Five-year proportions were as follows with respect to local recurrence-free survival, metastasis-free survival, and disease-specific survival/progression-free survival, respectively: 100%, 100%, and 100% following PDEMA; 82%, 96%, and 99% following excision/circumcision; 83%, 91%, and 95% following penectomy/glansectomy. A limitation is that this multi-institutional cohort study was not externally validated. CONCLUSIONS: Initial results are encouraging that PDEMA surgical management effectively controls early-stage penile squamous cell carcinoma.

Cuidado de Enfermagem e sexualidade em oncologia para o indivíduo penectomizado / Nursing care and sexuality in Oncology for penectomized individuals / Cuidado de Enfermería y sexualidad en oncología para el individuo que sufrió penectomía

Objetivo: proporcionar reflexões sobre o cuidado de enfermagem com abordagem à sexualidade para a saúde do homem penectomizado por câncer de pênis. Conteúdo: corresponde a estudo reflexivo construído a partir de leituras em produções científicas sobre o cuidado de Enfermagem e a sexualidade para o paciente oncológico penectomizado, à luz dos pensamentos e pressupostos ontológicos e teóricos de Martin Heidegger. Considerações finais: as novas condições impostas pelo adoecimento por câncer de pênis e o tratamento mutilador, a penectomia, exigem uma Enfermagem que aborde a sexualidade, considerando o indivíduo em sua totalidade e com ênfase no cuidado com perspectiva na profundidade e subjetividade existenciais humanas(AU)

Objective: to provide reflections on nursing care with an approach to sexuality for the health of men undergoing penectomy for penile cancer. Content: reflective study developed from readings in scientific productions on Nursing care and sexuality for the penectomized cancer patient, in the light of Martin Heidegger's ontological and theoretical thoughts and assumptions. Final considerations: the new conditions imposed by illness from penile cancer and the mutilating treatment, penectomy, require Nursing that addresses sexuality, considering the individual in its entirety and with an emphasis on care with a perspective on human existential depth and subjectivity(AU)

Objetivo: proporcionar reflexiones sobre el cuidado de Enfermería con abordaje a la sexualidad para la salud del hombre que sufrió penectomía por cáncer de pene. Contenido: corresponde a estudio reflexivo construido a partir de lecturas en producciones científicas sobre el cuidado de Enfermería y la sexualidad para el paciente oncológico que sufrió penectomía, a la luz de los pensamientos y presupuestos ontológicos y teóricos de Martin Heidegger. Consideraciones finales: las nuevas condiciones impuestas por la enfermedad por cáncer de pene y el tratamiento mutilador, la penectomía, exigen una Enfermería que aborde la sexualidad, considerando al individuo en su totalidad y con énfasis en el cuidado con perspectiva en la profundidad y subjetividad existenciales humanas(AU)

Risk of Local Recurrence in Men With Penile Intraepithelial Neoplasia in the Surgical Margin After Penile-sparing Surgery.

PURPOSE: Up to 90% of men with a positive surgical margin show remaining cancer in subsequent reresections. The risk of local recurrence in men with no penile cancer but the precancerous lesion penile intraepithelial neoplasia at the surgical margin is less well studied and was the aim of this analysis. MATERIAL AND METHODS: This was a retrospective analysis of men with distal penile cancer undergoing penile-sparing surgery. A competing risks survival analysis adjusted for grade, lymphovascular invasion, and stage was performed to assess local recurrence-free survival in patients with penile intraepithelial neoplasia-positive margins and completely negative surgical margins. RESULTS: A negative surgical margin was described in 319 men (85%), whereas penile intraepithelial neoplasia in the surgical margin was found in 59 men (15%). Local recurrence was observed in 30/319 men with a negative surgical margin compared to 11/59 men with penile intraepithelial neoplasia in the surgical margin. Adjusted for T stage and grade, patients with penile intraepithelial neoplasia at the surgical margin had a higher risk to develop a local recurrence than those with a negative surgical margin without penile intraepithelial neoplasia (HR 1.51, 95% CI 1.07-2.12, P = .019). CONCLUSIONS: Men with a penile intraepithelial neoplasia-positive surgical margin have an increased risk to experience local recurrence compared to men with a negative surgical margin and should undergo closer surveillance and/or adjuvant treatment.

Bilateral inguinal lymph-node dissection vs. unilateral inguinal lymph-node dissection and dynamic sentinel node biopsy in clinical N1 squamous cell carcinoma of the penis.

INTRODUCTION: To evaluate the role of unilateral inguinal lymph-node dissection (ILND) plus contralateral dynamic sentinel node biopsy (DSNB) vs. bilateral ILND in clinical N1 (cN1) penile squamous cell carcinoma (peSCC) patients. MATERIAL AND METHODS: Within our institutional database (1980-2020, included), we identified 61 consecutive cT1-4 cN1 cM0 patients with histological confirmed peSCC who underwent either unilateral ILND plus DSNB (26) or bilateral ILND (35). RESULTS: Median age was 54 years (Interquartile range [IQR]: 48-60 years). Median follow-up was 68 months (IQR 21-105 months). Most patients had pT1 (23 %) or pT2 (54.1%), as well as G2 (47.5%) or G3 (23%) tumors, while lymphovascular invasion (LVI) was present in 67.1% of cases. Considering a cN1 and a cN0 groin, overall 57 out of 61 patients (93.5%) had nodal disease in the cN1 groin. Conversely, only 14 out of 61 patients (22.9%) had nodal disease in the cN0 groin. 5-year IR-free survival was 91% (Confidence interval [CI] 80%-100%) for bilateral ILND group and 88% (CI 73%-100%) for the ipsilateral ILND plus DSNB group (P-value 0.8). Conversely, 5-year CSS was 76% (CI 62%-92%) for bilateral ILND group and 78% (CI 63%-97%) for the ipsilateral ILND plus contralateral DSNB group (P-value 0.9). CONCLUSIONS: In patients with cN1 peSCC the risk of occult contralateral nodal disease is comparable to cN0 high risk peSCC and the gold standard, namely bilateral ILND, may be replaced by unilateral ILND and contralateral DSNB without affecting positive node detection, IRRs and CSS.

Human papillomavirus in men / Virus del papiloma humano en hombres

Objective: To describe the clinical behavior of human papillomavirus in men. Materials and methods: Current international literature was reviewed to describe the clinical behavior of human papillomavirus in men. Results: Internationally, the overall prevalence of HPV DNA is 50.8%, HPV considered high risk are 14 types. Prevalence of HPV DNA in invasive penile cancer ranges from 33.1% to 47%. HPV-16 has been the most frequent (68.3%), followed by HPV-6 (8.1%) and HPV-18 (6.9%). Positive HPV is described as an independent prognostic factor for cancer-specific survival. Conclusion: It is not clear why HPV infection has a predilection in specific areas of the genital tract. However, it is important to note that there are factors that increase the risk of HPV infection. (AU)

Objetivo: Describir el comportamiento clínico del virus del papiloma humano en hombres. Materiales y métodos: Se revisó la literatura internacional actual para describir el comportamiento clínico del virus del papiloma humano en los hombres. Resultados: En el ámbito internacional, la prevalencia general del ADN del VPH es del 50,8%. Los VPH considerados de alto riesgo son 14 tipos. La prevalencia del ADN del VPH en el cáncer de pene invasivo oscila entre el 33,1% y el 47%, siendo el VPH-16 el más frecuente (68,3%), seguido del VPH-6 (8,1%) y del VPH-18 (6,9%). El VPH positivo se describe como un factor pronóstico independiente para la supervivencia específica del cáncer. Conclusión: No está claro por qué la infección por VPH muestra predilección por áreas específicas del tracto genital. Sin embargo, es importante tener en cuenta que existen factores que aumentan el riesgo de infección por VPH. (AU)

Patterns of Recurrence and Survival After Pelvic Treatment for Locally Advanced Penile Cancer.

Background: Penile cancer (PeCa) is rare, and the survival of patients with advanced disease remains poor. A better understanding of where treatment fails could aid the development of new treatment strategies. Objective: To describe the disease course after pelvic lymph node (LN) treatment for PeCa. Design setting and participants: We retrospectively analysed 228 patients who underwent pelvic LN treatment with curative intent from 1969 to 2016. The main treatment modalities were neoadjuvant chemotherapy, chemoradiation, and pelvic LN dissection. Outcome measurements and statistical analysis: In the case of multiple recurrence locations, the most distant location was taken and recorded as follows: local (penis), regional (inguinal and pelvic LN), and distant (any other location). A competing risk analysis was used to calculate the time to recurrence per location, and a Kaplan-Meier analysis was used for overall survival (OS). Results and limitations: The median follow-up of the surviving patients was 79 mo. The reason for pelvic treatment was pelvic involvement on imaging (29%), two or more tumour-positive inguinal LNs (61%), or inguinal extranodal extension (52%). More than half of the patients (61%) developed a recurrence. The median recurrence-free survival was 11 mo. The distribution was local in 9%, regional in 27%, and distant in 64% of patients. The infield control rate of nonsystemically treated patients was 61% (113/184). From the start of pelvic treatment, the median OS was 17 mo (95% confidence interval 12-22). After regional or distant recurrence, all but one patient died of PeCa with median OS after a recurrence of 4.4 (regional) and 3.1 (distant) mo. This study is limited by its retrospective nature. Conclusions: The prognosis of PeCa patients treated on their pelvis who recur despite locoregional treatment is poor. The tendency for systemic spread emphasises the need for more effective systemic treatment strategies. Patient summary: In this report, we looked at the outcomes of penile cancer patients in an expert centre undergoing various treatments on their pelvis. We found that survival is poor after recurrence despite locoregional treatment. Therefore, better systemic treatments are necessary.

Concomitant vs Staged Therapeutic Inguinal Lymphadenectomy in Clinically Node Positive Penile Squamous Cell Carcinoma: Does It Make a Difference?

PURPOSE: Inguinal lymph node dissection within 3 months of primary tumor resection in penile cancer has been associated with longer recurrence-free and cancer-specific survival. However, the optimal timing and effect of lymphadenectomy performed concurrently at the time of primary lesion management on oncologic outcomes in clinically lymph node positive penile squamous cell carcinoma remains unknown. MATERIALS AND METHODS: An international, multicenter cohort of 966 penile cancer cases was queried for penile squamous cell carcinoma management after the year 2000, clinically lymph node positive status, and performance of penile surgery and inguinal lymph node dissection. Cohorts were stratified as concomitant if inguinal lymph node dissection and penile surgery occurred on the same date or staged when inguinal lymph node dissection was performed after penile resection. Rates and patterns of penile squamous cell carcinoma recurrence were reported. Distant recurrence-free, cancer-specific, and overall survival were estimated using Kaplan-Meier analyses and groups compared with log-rank testing. RESULTS: Of 253 contemporary men with clinically lymph node positive penile squamous cell carcinoma, 96 (38%) underwent concomitant inguinal lymph node dissection and 157 (62%) had inguinal lymph node dissection performed in a staged manner. Penile cancer was most likely to recur distantly (19%) followed by in the groin (14%) or pelvis (5%). There were no differences in distant recurrence-free, cancer-specific, or overall survival between management strategies. Multivariable analysis adjusting for stage, treatment center, and perioperative chemoradiation also demonstrated no recurrence-free, cancer-specific, or overall survival benefit between management strategies. CONCLUSIONS: Inguinal lymph node dissection performed concurrently with excision of the penile tumor for clinically node positive penile squamous cell carcinoma is not associated with differences in recurrence-free, cancer-specific, or overall survival compared to staged lymph node dissection.

Effect of inguinal lymph node dissection in lymph node negative patients with squamous cell carcinoma of the penis.

INTRODUCTION: The survival benefit of inguinal lymph node dissection (ILND) vs no ILND in patients with squamous cell carcinoma of the penis (SCCP) and the absence of lymph node invasion is unclear. We addressed this uncertainty within the Surveillance, Epidemiology and End Results (SEER 2000-2018) database. MATERIAL AND METHODS: We identified lymph node negative SCCP patients who either underwent ILND (pN0) or clinical examination only (cN0). We tested for the effect of ILND vs no ILND on cancer-specific mortality (CSM) in Kaplan-Meier plots, univariable and multivariable Cox regression analyses, in a pT stage-specific fashion, before and after 1:3 propensity score matching (PSM). Sensitivity analyses were conducted according to historical and contemporary treatment periods as well as geographic regions. RESULTS: Of 2520 SCCP patients, 369 (15%) underwent ILND (pN0) vs 2151 (85%) did not (cN0). The pN0 vs cN0 distribution according to pT stages was as follows: 80 (7%) vs 1092 (93%) in pT1b, and 289 (21%) vs 1059 (79%) in pT2-3. At 36 months, CSM-free survival in pT2-3 stage was 89% in ILND vs 74% in no ILND patients (multivariable hazard ratio: 0.42, CI 0.30-0.60, p < 0.001). This result was confirmed in sensitivity analyses, and after 1:3 PSM. The same analyses could not be completed in pT1b stage due to insufficient number of observations and events. CONCLUSIONS: In pT2-3 stage SCCP, a significantly lower CSM was recorded in lymph node negative patients treated with ILND than in their clinical lymph node negative counterparts who did not undergo ILND.

Human papillomavirus in men.

OBJECTIVE: To describe the clinical behavior of human papillomavirus in men. MATERIALS AND METHODS: Current international literature was reviewed to describe the clinical behavior of human papillomavirus in men. RESULTS: Internationally, the overall prevalence of HPV DNA is 50.8%, HPV considered high risk are 14 types. Prevalence of HPV DNA in invasive penile cancer ranges from 33.1% to 47%. HPV-16 has been the most frequent (68.3%), followed by HPV-6 (8.1%) and HPV-18 (6.9%). Positive HPV is described as an independent prognostic factor for cancer-specific survival. CONCLUSION: It is not clear why HPV infection has a predilection in specific areas of the genital tract. However, it is important to note that there are factors that increase the risk of HPV infection.

Carcinoma de células escamosas de pene

Introducción: El cáncer de pene es una neoplasia maligna poco frecuente en todo el mundo; representa el 1 % de todos los cánceres que afectan a los hombres. Es una neoplasia caracterizada por un proceso proliferativo de células epiteliales, originándose a partir de la piel del prepucio interno o del glande, que se identifica por un crecimiento invasivo y diseminación metastásica temprana a ganglios linfáticos. Objetivo: Exponer la presentación clínica, diagnóstico y tratamiento de un hombre joven con cáncer de pene. Caso clínico: Paciente masculino de 31 años de edad, color de la piel blanca, con antecedentes de salud anterior y de procedencia urbana; que desde hace dos años presenta lesión ulcerosa, descamativa, granulosa en el pene; no dolorosa, con secreciones fétidas y que ha ido aumentando de tamaño. Con la aplicación de anestesia regional espinal se realizó penectomía parcial y se confirmó el diagnóstico de un carcinoma de células escamosas de pene. Conclusiones: El carcinoma de células escamosas de pene es infrecuente en hombres jóvenes y de buen pronóstico si es diagnosticado a tiempo y para cuyo diagnóstico se precisa ser especialmente estricto con los criterios histológicos. La penectomía parcial es el tratamiento de elección de la lesión primaria. El seguimiento de estos pacientes es fundamental para actuar de forma rápida ante la presencia de recidiva o adenopatías metastásicas.

Introduction : Cancer of the penis is a rare malignant neoplasm worldwide; it represents 1 % of all cancers that affect men. It is a neoplasm characterized by a proliferative process of epithelial cells, originating from the skin of the inner prepuce or glans penis, which is identified by invasive growth and early metastatic spread to lymph nodes. Objective : To expose the clinical presentation, diagnosis and treatment of a young man with penile cancer. Clinical case : Male patient 31 years of age, white skin color, with a history of previous health and urban origin; that for two years has had ulcerative, decamative, granulous lesion on the penis; not painful, with fetid secretions and that has been increasing in size. With the application of regional spinal anesthesia, partial penectomy was performed and the diagnosis of squamous cell carcinoma of the penis was confirmed. Conclusions : Squamous cell carcinoma of the penis is uncommon in young men and has a good prognosis if it is diagnosed early and for whose diagnosis it is necessary to be especially strict with the histological criteria. Partial penectomy is the treatment of choice for the primary lesion. The follow-up of these patients is essential to act quickly in the presence of recurrence or metastatic adenopathies.

Epidemiological study of penile cancer in a northeastern state - Brazil / Estudo epidemiológico do câncer de pênis em um estado do Nordeste - Brasil

ABSTRACT Objective: to trace the clinical and epidemiological profile of penile cancer in Rio Grande do Norte/Brazil and relate them to data published in the literature. Methods: a cross-sectional study was conducted with 94 patients diagnosed with penile cancer in 2011-2018, treated at the Liga Norte Riograndense Contra o Cancer. Results: all patients were diagnosed with squamous cell carcinoma, mainly aged over 50 years, from the states interior, brown, illiterate, or with incomplete primary education. At diagnosis, 68% of patients were classified as having tumors =T2, and 30% had lymph node involvement. Distant metastases were detected in 2.1% of patients at diagnosis. Most patients received the diagnosis in the initial phase of the disease, but 20.2% were diagnosed in stage IV. Partial penectomy was the most performed surgery, and 10% of patients relapsed, mainly in the lymph nodes (87.5%). The mean follow-up of the patients was 18 months, with an estimated overall survival at five years of 59.1%. However, 25% of patients were followed up for up to 3 months, losing follow-up. Conclusion: the State of Rio Grande do Norte has a high incidence of penile cancer with a high frequency of locally advanced tumors at diagnosis and in younger patients younger than 50. Furthermore, socioeconomic factors interfere with early diagnosis and hinder access to specialized services.

RESUMO Objetivo: traçar o perfil clínico e epidemiológico do câncer de pênis no Rio Grande do Norte/Brazil e relacioná-los com dados publicados na literatura. Métodos: realizou-se estudo transversal de 94 pacientes diagnosticados com câncer de pênis no período de 2011-2018, tratados na Liga Norte Riograndense Contra o Câncer. Resultados: todos os pacientes foram diagnosticados com carcinoma espinocelular, principalmente com idade acima dos 50 anos, provenientes do interior do estado, pardos, analfabetos ou com ensino fundamental incompleto. Ao diagnóstico, 68% dos pacientes foram classificados com tumores =T2 e 30% possuiam envolvimento linfonodal. Metástases à distância foram detectadas em 2,1% dos pacientes ao diagnóstico. A maioria dos pacientes recebeu o diagnóstico na fase inicial da doença, mas 20,2% foram diagnosticados em estádio IV. Penectomia parcial foi a cirurgia mais realizada e 10% dos pacientes recidivaram, principalmente para linfonodos (87,5%). A média de seguimento dos pacientes foi de 18 meses, apresentando estimativa de sobrevida global em 5 anos de 59,1%. No entanto, 25% dos pacientes foram acompanhados por até 3 meses, perdendo o seguimento. Conclusão: o Estado do Rio Grande do Norte apresenta elevada incidência de câncer de pênis com alta frequência de tumores localmente avançados ao diagnóstico, assim como em pacientes mais jovens, menores que 50 anos de idade. Outrossim, o fator socioeconômico interfere no diagnóstico precoce e dificulta o acesso a serviços especializados. .

A single-center comparison of our initial experiences in treating penile and urethral cancer with video-endoscopic inguinal lymphadenectomy (VEIL) and later experiences in melanoma cases.

Background: Video-endoscopic inguinal lymphadenectomy (VEIL) is a minimally invasive approach that is increasingly indicated in oncological settings, with mounting evidence for its long-term oncological safety. Objectives: To present our single-center experience of treating penile and urethral cancer with VEIL, as well as its more recent application in melanoma patients. Methods: We prospectively recorded our experiences with VEIL from September 2010 to July 2018, registering the patient primary indication, surgical details, complications, and follow-up. Results: Twenty-nine patients were operated in one (24) or both (5) groins; 18 had penile cancer, 1 had urethral cancer, and 10 had melanoma. A mean 8.62 ± 4.45 lymph nodes were removed using VEIL and of these, an average of 1.00 ± 2.87 were metastatic; 16 patients developed lymphocele and 10 presented some degree of lymphedema; there were no skin or other major complications. The median follow-up was 19.35 months; there were 3 penile cancer patient recurrences in the VEIL-operated side. None of the melanoma patients presented a lymphatic inguinal recurrence. Conclusions: VEIL is a minimally invasive technique which appears to be oncologically safe showing fewer complications than open surgery. However, complications such as lymphorrhea, lymphocele, or lymphedema were not diminished by using VEIL.