Organ sparing surgery for the management of localized penile cancer has the potential to maintain penile form and function while achieving equivalent oncologic control as partial or total penectomy. Mohs surgery is efficacious for the treatment of non-genital and cutaneous cancers and although it is endorsed by NCCN guidelines for low stage penile cancer management, there is a paucity of data on cancer outcomes in in localized penile cancer. The purpose of this study was to determine oncologic outcomes in patients with localized penile carcinoma managed with Mohs Surgery.

All patients from 2010-2020 with penile carcinoma at the University of North Carolina were seen in a multidisciplinary setting including urologic oncology, dermatology, and reconstructive urology. Patients with Ta, Tis, T1 and T2 disease were considered candidates for Mohs surgery. Patients undergoing Mohs surgery were identified using a prospectively maintained database and clinical and pathologic data were collected for descriptive analysis. Variables included: lesion location, tumor grade, stage, overall survival (OS) and recurrence free survival (RFS).

43 patients met inclusion criteria. Patient characteristics are summarized in Table 1. Mean age at diagnosis was 61.4 years. Stage distribution was Ta in 4.7% (n=2), Tis in 58.1% (n=25), T1a in 14.0% % (n=6), T1b in 7.0% (n=3), and T2 in 16.3% (n=7). Grade distribution was 14% Grade 1 (n=6), 14% (n=6) Grade 2, 37.2% Grade 3-4 (n=16), and 34.9% unknown (n=15). Lesions were predominantly located on the glans (41.9%). No patients had a positive surgical margin after Mohs. 46.5% (n=20) patients received combined reconstructive urologic repair following Mohs. RFS was 93.0% with 3 patients (7%) recurring. 2 (66%) patients (1 with T2, 1 with Tis) exhibited local recurrence within 6 months, were treated with local resection and found to be Tis. One patient with T1b disease had T1bN2 recurrence at 2 years that was treated with TIP. OS was 97.7%, with 1 death from non-cancer related causes.

Mohs surgery provides effective long-term local control for localized penile cancer with an OS of 97.7% and an RFS of 93.0%. Future studies are needed to assess benefits in functional outcomes among men treated with Mohs surgery. A multi-disciplinary team involving urologic oncology, reconstructive urology, and Mohs surgery is essential to patient management.