Penis-Sparing Surgery with Neo-Glans Reconstruction for Benign, Premalignant or Malignant Penile Lesions

Abstract

Penile neoplasm is an uncommon malignancy affecting less than 1 out of 100000 males in Europe and in the United States. Seventy-eight percent of all tumours appear on the glans and/or prepuce [1,2]. Many of these lesions are red, moist patches which can be misdiagnosed as either a benign skin condition (i.e. Zoon’s balanitis or lichen planus) or a premalignant lesion such as the lichen sclerosus (LS) that, if left untreated, has the risk of progression to invasive squamous cell carcinoma in 5 to 33% of the cases [3]. Beyond all, both benign, premalignant and malignant lesions may cause pruritus, pain, bleeding, crusting and difficulties in retracting the foreskin, and overall psychosexual disability. The treatment of benign, premalignant and malignant penile lesions has changed over time [4,5]. Traditional penile surgery is associated with a mutilating approach, eventually characterized by a high incidence of aesthetic, dysfunctional and psychological postoperative disorders [6-8]. In this context, the use of either medical or topical surgical treatments has been supported with the specific aim to maintain a good functional and aesthetic penile shaft; topical chemotherapy, laser ablation, cryotherapy, and local excisions have been thus reported in the scientific literature [3, 4]. However, these techniques are associated with high failures rates and unsightly scarring that impacts on penile appearance and sexual activity. Recently in patients with either premalignant or malignant superficial lesions, alternative forms of surgical therapy have aimed at preserving the phallus without jeopardizing local cancer control have been extensively suggested. These organ-sparing techniques, providing the reconstruction of an aesthetic neo-glans without any impairment of patient’s survival have also been suggested for more advanced tumours [1 3, 9].