Does residual penile intraepithelial neoplasia (PeIN) require adjuvant chemotherapy after surgical excision?
Author(s):
Dr. Mahmoud Ziada
,
Dr. Mahmoud Ziada
Affiliations:
Mr. Ari Parnham
,
Mr. Ari Parnham
Affiliations:
Miss Michelle Christodoulidou
,
Miss Michelle Christodoulidou
Affiliations:
Dr. Alex Freeman
,
Dr. Alex Freeman
Affiliations:
Mr. Asif Muneer
,
Mr. Asif Muneer
Affiliations:
Prof. Christopher Bunker
Prof. Christopher Bunker
Affiliations:
BAUS ePoster online library. Ziada M. 06/27/17; 177376; P4-10
Mahmoud Ziada
Mahmoud Ziada
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Abstract
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INTRODUCTION AND OBJECTIVES:
Penile carcinoma in situ (CIS) or PeIN III, can progress to invasive squamous cell carcinoma (SCC) in up to 30% of patients. The primary surgical treatment is circumcision and pathological review often shows residual CIS at the margins following circumcision. The aim of this study was to review our cohort of patients with positive margins following surgery in order to assess requirement for topical chemotherapy (5% 5-FU), curettage or close surveillance.

METHODS: A total of 84 patients were identified with biopsy proven CIS and residual disease. Adjuvant treatment mainly used topical 5-FU with additional corticosteroid treatment. A retrospective review of this cohort recorded the type of adjuvant treatment and the progression rate.

RESULTS: A total of 84 patients with follow up data were diagnosed with penile CIS and treated surgically. A total of 45 patients underwent a circumcision only, 8 underwent a wide local excision and 11 underwent a glans resurfacing.The remainder underwent a combination of curettage and cautery. Pathological review identified 62 (74%) patients diagnosed with HPV related undifferentiated PeIN III and 18 with differentiated PeIN III. Following surgery only 8 patients required topical 5-FU treatment despite the presence of positive margins.

CONCLUSION:
This study indicates that 5-FU is only required in a small proportion of patients (8/84; 9.5%) following surgical excision with positive margins. The majority of patients requiring adjuvant treatment were diagnosed with undifferentiated PeIN III. With this cohort there does not appear to be any increased risk of progression to invasive SCC.
INTRODUCTION AND OBJECTIVES:
Penile carcinoma in situ (CIS) or PeIN III, can progress to invasive squamous cell carcinoma (SCC) in up to 30% of patients. The primary surgical treatment is circumcision and pathological review often shows residual CIS at the margins following circumcision. The aim of this study was to review our cohort of patients with positive margins following surgery in order to assess requirement for topical chemotherapy (5% 5-FU), curettage or close surveillance.

METHODS: A total of 84 patients were identified with biopsy proven CIS and residual disease. Adjuvant treatment mainly used topical 5-FU with additional corticosteroid treatment. A retrospective review of this cohort recorded the type of adjuvant treatment and the progression rate.

RESULTS: A total of 84 patients with follow up data were diagnosed with penile CIS and treated surgically. A total of 45 patients underwent a circumcision only, 8 underwent a wide local excision and 11 underwent a glans resurfacing.The remainder underwent a combination of curettage and cautery. Pathological review identified 62 (74%) patients diagnosed with HPV related undifferentiated PeIN III and 18 with differentiated PeIN III. Following surgery only 8 patients required topical 5-FU treatment despite the presence of positive margins.

CONCLUSION:
This study indicates that 5-FU is only required in a small proportion of patients (8/84; 9.5%) following surgical excision with positive margins. The majority of patients requiring adjuvant treatment were diagnosed with undifferentiated PeIN III. With this cohort there does not appear to be any increased risk of progression to invasive SCC.
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