Local recurrence of squamous cell carcinoma of the penis.

Given the excellent local control rates achieved with partial penectomy, it is important to consider laser treatment or radiation therapy of squamous cell carcinoma of the penis cautiously. Emotional issues surrounding preservation of a functional penis should not be allowed to compromise adequate therapy. On the other hand, some penile cancers undoubtedly can be managed adequately by techniques other than partial penectomy. The fundamental question is, then, how great a compromise laser treatment or radiation therapy introduces. In patients who present with bulky, long-neglected penile cancers, the point is moot: Partial or even total penectomy is indicated. However, other treatments are feasible in many patients, and an attempt at functional organ preservation should not be restricted simply to the rare small tumor. Lesions up to 2 cm in size can be controlled adequately without amputation. Because tumor grade correlates highly with depth of invasion, the presence of nodal metastasis, and survival, most poorly differentiated squamous cell tumors of the penis probably should be treated by amputation. As mentioned above, it may be several months after laser treatment or radiation therapy before local treatment failure is recognized. Although this is a concern, it probably does not ultimately result in therapeutic compromise in most patients. With most urologic cancers, local recurrence equates with the inability to cure the patient and, ultimately, death. With locally recurrent carcinoma of the penis, however, the situation can be salvaged by converting to partial penectomy. Thus, the patient compromises his chances for cure only if tumor dissemination occurs during the few months between the end of treatment and recognition of failure.