Question

A 55-year-old male presented with verrucous carcinoma around the glans of the penis. Examination reveals that the inguinal lymph nodes are not enlarged. What is the appropriate management for this patient?

• A. Total penectomy
• B. CO2 laser excision
• C. Topical 5-fluorouracil
• D. Partial penectomy

Answer 1

The Correct Option is D

A 55-year-old male presented with verrucous carcinoma around the glans of the penis, a situation that requires consideration of effective treatment options. Verrucous carcinoma, a variant of squamous cell carcinoma, is slow-growing and locally invasive, but it rarely metastasizes. Considering the lack of enlarged inguinal lymph nodes indicates an absence of regional metastasis, aggressive treatment might not be necessary.

Given the location around the glans of the penis, the key is to remove the cancerous tissue while preserving as much of the surrounding healthy tissue as possible to maintain function and quality of life. Here we explore the options:

• Total penectomy: This involves the complete removal of the penis. It is used for advanced or extensive lesions but is not justified given the localized nature of the verrucous carcinoma in this patient.
• CO2 laser excision: This is less invasive and used for smaller lesions but might not be effective for deeper tissue invasion associated with verrucous carcinoma.
• Topical 5-fluorouracil: Primarily acts on superficial lesions and not typically effective for verrucous carcinoma since it involves deeper tissues.
• Partial penectomy: Involves removing the affected part of the penis while preserving as much function as possible. This treatment offers clear margins and minimizes recurrence by thoroughly excising the carcinoma.

Considering these points, partial penectomy is the most appropriate management for this patient. It ensures adequate removal of the verrucous carcinoma with clear margins, minimizes the risk of recurrence, and maintains penile functionality.