The histological extent of the local spread of carcinoma of the penis and its therapeutic implications

Objective To explore the possibility of reducing the margin of clearance at surgery for carcinoma of the penis without causing an increase in the inci dence of local tumour recurrence, so that the functional and cosmetic compr omise associated with penectomy might be minimized, Patients and methods Sixty-four patients underwent partial or total penecto my based on the extent of tumour, The specimens were evaluated histological ly for grade and for proximal microscopic extensions beyond the grossly vis ible tumour margin, by examining serial proximal 5 mm sections, The histolo gical grade of the lesion was correlated with its clinical site, morphology and proximal microscopic spread. Differences were assessed using the chi-s quared test, Results Of 64 tumours, 31% were grade 1, 50% grade 2 and the remaining 19% grade 3. Higher grade lesions were more likely to involve the penile shaft, The maximum proximal histological extent was 5 mm for grades 1 and 2, and 10 mm for grade 3 tumours; there was no discontinuous spread. Conclusions Histological grading is mandatory in the management of carcinom a of the penis. A.10-mm clearance is adequate for grade 1 and 2 lesions, an d 15 mm for grade 3 tumours. This approach would qualify more patients for partial rather than total amputation; the residual length of the penis woul d then be cosmetically and functionally more acceptable.