LASER THERAPY OF SQUAMOUS-CELL DYSPLASIA AND CARCINOMA OF THE PENIS

Objectives. To analyze the influence of etiologic factors and practica l issues regarding the merits, limitations, and long-term results of a ggressive laser treatment of premalignant and malignant squamous cell lesions of the penis. Methods. Preparation of genital skin with 5% ace tic acid and mapping biopsies of lesions and the surrounding field-of- change were performed in 52 men evaluated and subsequently treated wit h laser during a 10-year period. Most men (81%) were or had been smoke rs, and many (46%) had female sexual partners infected with human papi llomavirus. Carbon dioxide laser was used for low-stage lesions; potas sium-titanylphosphate/532 or neodymium:yttrium-aluminum-garnet laser w as used for more histologically advanced lesions. Not only the lesions but also-the entire human papillomavirus-induced field-of-change was treated. Circumcision was performed simultaneously in 28 previously un circumcised patients. Results. All lesions demonstrated aceto-whitenin g and histologic changes of human papillomavirus infection. Human papi llomavirus DNA was detected in 93.5% of the specimens from 31 patients studied. Of the 52 patients, 22 (42%) had dysplastic premalignant pen ile intraepithelial neoplasia, and the remaining 30 (58%) had squamous cell carcinoma. Forty-four patients were available for follow-up from 12 to 117 months (average 58). Overall, 5 patients (11.4%) experience d a recurrence: 3 were successfully re-treated with laser, and 2 patie nts underwent partial penectomy, 1 of whom with squamous cell carcinom a Stage T2 died of metastatic disease. Conclusions. Aggressive laser t herapy of the visible lesions and of the entire dysplastic premalignan t field-of-change produces excellent cosmetic results. The entire peni s and, therefore, its full sexual functional potential are preserved. The low rate of local recurrence over the long term in all but deeply invasive (T2) lesions compares favorably with the outcome of other, mo re conventional therapies. Irrespective of therapeutic approach, close and long-term surveillance of all patients and counseling for their s exual partners are mandatory. UROLOGY 52: 559-565, 1998. (C) 1998, Els evier Science Inc. All rights reserved.