Latest updates in Mohs micrographic surgery for the management of penile squamous cell carcinoma

Abstract

reported, with an estimated minimum prevalence of 4.9%. 1 Although BP patients with laryngeal lesions are usually asymptomatic, they can present with hoarseness, stridor, with or without dyspnea in severe cases. 4 We were unable to find previous reports of cases of BP that presented with acute progressive laryngeal involvement requiring emergency tracheostomy. The supraglottis is the most commonly affected laryngeal site in the pemphigoid. Erythematous and edematous laryngeal mucosa with multiple erosions were observed on fiber-optic laryngoscopy. Imaging tests, such as computed tomography, are also needed to evaluate the extent of the disease and assist in the differential diagnosis. An initial airway evaluation using fiber-optic laryngoscopy is required to determine whether a tracheostomy is necessary. Early and aggressive systemic treatment is necessary to prevent airway stenosis and obstruction in BP with laryngeal involvement.Therefore, management with systemic corticosteroids is recommended, with close follow-up to monitor the resolution of laryngeal lesions.In summary, we report a case of BP with laryngeal involvement that presented with critical airway narrowing, requiring emergency tracheostomy. Laryngeal involvement in patients with BP can result in life-threatening airway stenosis and obstruction. BP patients with suspected laryngeal involvement should be promptly evaluated by an otolaryngologist. Although rare, dermatologists should be aware of this since it is a potentially severe complication of BP.

Total Margin Control Is Superior to Traditional Margin Assessment for Treatment of Low-Stage Penile Squamous Cell Carcinoma

“…Current NCCN and EAU-ASCO guidelines recommend glansectomy, WLE, and laser therapy for treatment of low-stage disease, with NCCN citing LRRs of 9%, 25%, and 18%, respectively. 6,9 While few studies have evaluated outcomes of PDEMA in PSCC, [13][14][15][16][17][18][19] the largest cohort to date of 85 PSCC cases treated with Mohs reported a low LR rate of 1.2%. Authors of this cohort study called for consensus guidelines with clear indications for Mohs excision for persons with penises with genital cancer.…”

“…17 Other studies evaluating PDEMA for PSCC have demonstrated LR risks ranging from 6% to 32%. 13,14,18,19 Positive surgical margins in PSCC have been associated with both increased risk of LR and death. 7,22 Study authors advise clinicians to strive for negative margins to decrease poor outcomes for patients.…”

“…19 Four of 7 included studies reported tumor staging, with authors noting a lower LRR for PSCCis treated with Mohs (4.1%) in comparison to invasive SCC (16.9%). 19 Currently no studies compare PDEMA to other surgical options for the treatment of PSCC. Based on data showing PDEMA to have superior outcomes for cutaneous SCC, 20,21 we sought to determine if there are differences in outcomes in patients with low-stage PSCC treated with PDEMA compared with other surgical treatment (circumcision/excision and penectomy/glansectomy).…”

“…19 Four of 7 included studies reported tumor staging, with authors noting a lower LRR for PSCCis treated with Mohs (4.1%) in comparison to invasive SCC (16.9%). 19…”

“…12 Only a handful of studies have evaluated outcomes for PDEMA in PSCC. [13][14][15][16][17][18][19] Recently, the largest cohort to date was published (63 PSCCis, 22 PSCC), showing low local recurrence rates (LRRs; 1.2%, 1/85) and high patient-reported satisfaction with functional outcomes. 17 A systematic review by Assaf et al studying outcomes of Mohs excision for PSCC reported combined LRR of 7.7% for 246 tumors, lower than the published LRR for OSS of 21.2%.…”