Presentation Authors: Alexander Skokan*, Raju Chelluri, Leilei Xia, Matthew Heavner, Ibardo Zambrano, Christopher Miller, Robert Caleb Kovell, Philadelphia, PA
Introduction: For low risk penile squamous cell carcinoma (SCC) and carcinoma in situ (CIS), there are many options for management with little data to drive shared decision-making about outcomes with each approach. The need for staged surgery with genital reconstruction in some cases adds potential morbidity after oncologic resection. We hypothesize that clinical tumor characteristics would be predictive of surgeon involvement in complex reconstruction or closure after Mohs resection.
Methods: A retrospective review was conducted of a prospectively collected database including all patients who underwent genitourinary (GU) Mohs resection from 2005 - 2018 at a single academic referral center. All patients undergoing resection for penile or scrotal SCC or CIS were included. Demographics, Mohs procedure details, pathologic staging, and need for adjuvant oncologic surgery or reconstructive surgery were reviewed.
Results: Of 148 cases undergoing GU Mohs, 99 patients were included who had 108 discrete lesions removed. Among cases with penile cancer, glans involvement (p < 0.001) and lesions 3cm or larger (p=0.002) were more likely to be referred after Mohs for formal reconstruction. Inability to clear the lesion with positive margins was strongly correlated with referral for more aggressive cancer management (p < 0.001), and while not statistically significant, there was indication that patients with high risk pathologic features were referred for further oncologic management (T1b or higher penile cancer, p=0.056). Resection of recurrent tumors was not associated with referral after Mohs (p=0.30). Fourteen patients underwent skin grafting and 16 were closed with tissue flaps, while 10 were closed primarily after referral.
Conclusions: Mohs can be considered for aggressive tissue preservation in appropriately selected low risk patients, but a significant fraction of patients will require more advanced reconstruction. Patients with lesions located on the glans or large shaft lesions and possibly patients with more aggressive pathology are more likely to require a second operation. These patients may be well served with a collaborative, multi-specialty approach aimed at optimizing resection with coordinated planned reconstruction from the earliest planning stages.