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Ahmed ME, Khalil MI, Kamel MH, Karnes RJ, Spiess PE. Progress on Management of Penile Cancer in 2020. Curr Treat Options Oncol 2020; 22:4. [PMID: 33230601 DOI: 10.1007/s11864-020-00802-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
OPINION STATEMENT Management of penile cancer represents a challenge to urologic oncologists due to the disease's rarity and sparse data in the literature. Squamous cell carcinoma represents the most common histologic subtype of penile cancer. Penile cancer has a disastrous effect on patients' psychological and physical health. Penile cancer accounts for approximately 1% of cancer deaths in the USA annually. However, in recent years, the management of penile cancer has achieved marked progress in both diagnostic and therapeutic approaches with the intent to avoid radical surgeries. The traditional total penile amputation has been replaced by penile preserving procedures in many patients. Nowadays, total penile amputation (total penectomy) is preserved only for patients with proximal lesions. The introduction of minimally invasive surgical techniques in the management of penile cancer-infiltrated lymph nodes has been reported. Given the dismal prognosis with conventional cytotoxic therapies, new systemic therapies have been investigated in patients with locally advanced or metastatic penile cancer. Multiple studies have shown promising outcomes. All these efforts have resulted in a remarkable improvement in patient quality of life. The objectives of our review are to update clinicians on the advances in the management of penile cancer and to summarize the recent guidelines and recommendations.
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Affiliation(s)
| | - Mahmoud I Khalil
- Department of Urology, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA
| | - Mohamed H Kamel
- Department of Urology, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA
| | | | - Philippe E Spiess
- Department of Genito-Urinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA. .,Department of GU Oncology and Tumor Biology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA. .,Urology and Oncology, University of South Florida, Tampa, FL, USA.
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Kravvas G, Ge L, Ng J, Shim TN, Doiron PR, Watchorn R, Kentley J, Panou E, Dinneen M, Freeman A, Jameson C, Haider A, Francis N, Minhas S, Alnajjar H, Muneer A, Bunker CB. The management of penile intraepithelial neoplasia (PeIN): clinical and histological features and treatment of 345 patients and a review of the literature. J DERMATOL TREAT 2020; 33:1047-1062. [DOI: 10.1080/09546634.2020.1800574] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- G. Kravvas
- Department of Dermatology, University College London Hospitals, London, UK
| | - L. Ge
- Department of Dermatology, University College London Hospitals, London, UK
| | - J. Ng
- Department of Dermatology, Chelsea & Westminster Hospital, London, UK
| | - T. N. Shim
- Department of Dermatology, University College London Hospitals, London, UK
| | - P. R. Doiron
- Department of Dermatology, University College London Hospitals, London, UK
| | - R. Watchorn
- Department of Dermatology, University College London Hospitals, London, UK
| | - J. Kentley
- Department of Dermatology, Chelsea & Westminster Hospital, London, UK
| | - E. Panou
- Department of Dermatology, University College London Hospitals, London, UK
| | - M. Dinneen
- Department of Urology, Chelsea & Westminster Hospital, London, UK
| | - A. Freeman
- Department of Histopathology, University College London Hospitals, London, UK
| | - C. Jameson
- Department of Histopathology, University College London Hospitals, London, UK
| | - A. Haider
- Department of Histopathology, University College London Hospitals, London, UK
| | - N. Francis
- Department of Histopathology, Imperial College Hospitals, London, UK
| | - S. Minhas
- Department of Urology, Imperial College Hospitals, London, UK
| | - H. Alnajjar
- Department of Urology, University College London Hospitals, London, UK
| | - A. Muneer
- Department of Urology, University College London Hospitals, London, UK
| | - C. B. Bunker
- Department of Dermatology, University College London Hospitals, London, UK
- Department of Dermatology, Chelsea & Westminster Hospital, London, UK
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3
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Young TK, Gutierrez D, Zampella JG. An Overview of Penile and Scrotal Dermatoses. Urology 2020; 142:14-21. [DOI: 10.1016/j.urology.2020.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/22/2020] [Accepted: 04/05/2020] [Indexed: 11/16/2022]
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4
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Successes of photodynamic therapy in treatment of erythroplasia of Queyrat. BIOMEDICAL PHOTONICS 2020. [DOI: 10.24931/2413-9432-2020-9-1-34-41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Chen ELA, Srivastava D, Nijhawan RI. Mohs Micrographic Surgery: Development, Technique, and Applications in Cutaneous Malignancies. Semin Plast Surg 2018; 32:60-68. [PMID: 29765269 DOI: 10.1055/s-0038-1642057] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Mohs micrographic surgery (MMS) is a specialized technique for treating skin malignancies that offers the highest cure rate by allowing histological evaluation of the entire peripheral and deep margins. MMS also maximally preserves as much uninvolved, normal adjacent tissue as possible, allowing for the best cosmetic and functional outcomes. When used for appropriate indications, this technique is also more cost-effective than other treatment modalities. In this article, the authors will discuss the development of MMS, the steps involved in this procedure, and the indications for this technique. They will also review the use of MMS for basal cell carcinoma, squamous cell carcinoma, melanoma in situ, and some less common skin malignancies.
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Affiliation(s)
- Eillen Luisa A Chen
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Divya Srivastava
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
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Wollina U, Schönlebe J, Goldman A, Tchernev G, Lotti T. Simultaneous Occurrence of Balanoposthitis Circumscripta Plasmacellularis Zoon, Phimosis and in Situ Carcinoma of the Penis: Case Report with An Unusual Ulcerated Polypoid Variant of Zoon's Disease and a Carcinoma in Situ of Reserve Cell Type. Open Access Maced J Med Sci 2018; 6:61-63. [PMID: 29483984 PMCID: PMC5816318 DOI: 10.3889/oamjms.2018.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/17/2017] [Accepted: 10/29/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Zoon's balanitis is a benign disease characterized by an asymptomatic, chronic, solitary, shiny, red-orange plaque of the glans and/ or prepuce. In rare cases of Zoon's disease, penile squamous cell carcinoma developed in the chronic inflammatory lesions. CASE REPORT We report on a 68-year-old male patient presenting with phimosis and coexistent Zoon's disease and penile carcinoma in situ treated successfully by circumcision. CONCLUSION Coexistence of both lesions in contrast to the development of cancerous lesions within pre-existent Zoon's disease is a very rare observation.
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Affiliation(s)
- Uwe Wollina
- Städtisches Klinikum Dresden, Department of Dermatology and Allergology, 01067 Dresden, Germany
| | - Jacqueline Schönlebe
- Städtisches Klinikum Dresden - Institute of Pathology “Georg Schmorl”, Dresden, Germany
| | | | - Georgi Tchernev
- Medical Institute of Ministry of Interior (MVR), Department of Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
- Onkoderma - Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
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Zreik A, Rewhorn M, Vint R, Khan R, Hendry D. Carbon dioxide laser treatment of penile intraepithelial neoplasia. Surgeon 2017; 15:321-324. [DOI: 10.1016/j.surge.2016.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 11/11/2016] [Accepted: 11/17/2016] [Indexed: 10/20/2022]
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Chipollini J, Yan S, Ottenhof SR, Zhu Y, Draeger D, Baumgarten AS, Tang DH, Protzel C, Ye DW, Hakenberg OW, Horenblas S, Watkin NA, Spiess PE. Surgical management of penile carcinoma in situ
: results from an international collaborative study and review of the literature. BJU Int 2017; 121:393-398. [DOI: 10.1111/bju.14037] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Juan Chipollini
- Department of Genitourinary Oncology; H. Lee Moffitt Cancer Center & Research Institute; Tampa FL USA
| | - Sylvia Yan
- Department of Urology; St George׳s Healthcare NHS Trust; London UK
| | - Sarah R. Ottenhof
- Department of Urological Oncology; Netherlands Cancer Institute; Amsterdam The Netherlands
| | - Yao Zhu
- Department of Urology; Fudan University Shanghai Cancer Center; Shanghai China
| | - Désirée Draeger
- Department of Urology; University Hospital Rostock; Rostock Germany
| | - Adam S. Baumgarten
- Department of Urology; University of South Florida Morsani College of Medicine; Tampa FL USA
| | - Dominic H. Tang
- Department of Genitourinary Oncology; H. Lee Moffitt Cancer Center & Research Institute; Tampa FL USA
| | - Chris Protzel
- Department of Urology; University Hospital Rostock; Rostock Germany
| | - Ding-wei Ye
- Department of Urology; Fudan University Shanghai Cancer Center; Shanghai China
| | | | - Simon Horenblas
- Department of Urological Oncology; Netherlands Cancer Institute; Amsterdam The Netherlands
| | | | - Philippe E. Spiess
- Department of Genitourinary Oncology; H. Lee Moffitt Cancer Center & Research Institute; Tampa FL USA
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Nam JK, Lee DH, Park SW, Kam SC, Lee KS, Kim TH, Kim TS, Oh CK, Park HJ, Kim TN. Clinicopathologic Characteristics and Treatment Outcomes of Penile Cancer. World J Mens Health 2017; 35:28-33. [PMID: 28459145 PMCID: PMC5419113 DOI: 10.5534/wjmh.2017.35.1.28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/04/2017] [Accepted: 02/06/2017] [Indexed: 12/01/2022] Open
Abstract
Purpose The aim of this study was to assess the clinicopathologic characteristics of penile cancer, including patterns of therapy, oncologic results, and survival. Materials and Methods Between January 2005 and July 2015, 71 patients at 6 institutions who had undergone penectomy or penile biopsy were enrolled. Their medical records were reviewed to identify the mode of therapy, pathology reports, and cancer-specific survival (CSS) rate. Results Clinicopathologic and outcome information was available for 52 male patients (mean age, 64.3 years; mean follow-up, 61.4 months). At presentation, 17 patients were node-positive, and 4 had metastatic disease. Management was partial penectomy in 34 patients, total penectomy in 12 patients, and chemotherapy or radiotherapy in 6 patients. The pathology reports were squamous cell carcinoma in 50 patients and other types of carcinoma in the remaining 2 patients. Kaplan-Meier survival analysis showed a 5-year CSS rate of 84.0%. In univariate and multivariate analyses, the American Joint Committee on Cancer (AJCC) stage and pathologic grade were associated with survival. Conclusions Partial penectomy was the most common treatment of penile lesions. The oncologic outcomes were good, with a 5-year CSS of 84.0%. The AJCC stage and pathologic grade were independent prognostic factors for survival.
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Affiliation(s)
- Jong Kil Nam
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dong Hoon Lee
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sung Woo Park
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sung Chul Kam
- Department of Urology, Gyeongsang National University Hospital, Jinju, Korea
| | - Ki Soo Lee
- Department of Urology, Dong-A University Hospital, Busan, Korea
| | - Tae Hyo Kim
- Department of Urology, Dong-A University Hospital, Busan, Korea
| | - Taek Sang Kim
- Department of Urology, Kosin University Gospel Hospital, Busan, Korea
| | - Cheol Kyu Oh
- Department of Urology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Hyun Jun Park
- Department of Urology, Pusan National University Hospital, Busan, Korea
| | - Tae Nam Kim
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea.
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11
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Chipollini J, Tang DH, Sharma P, Baumgarten AS, Spiess PE. Patterns of Regional Lymphadenectomy for Clinically Node-negative Patients With Penile Carcinoma: Analysis From the National Cancer Database From 1998 to 2012. Clin Genitourin Cancer 2017; 15:670-677.e1. [PMID: 28522287 DOI: 10.1016/j.clgc.2017.04.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/07/2017] [Accepted: 04/14/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Evidence supports upfront regional lymphadenectomy (rND) when primary penile tumors exhibit high-risk features and negative inguinal adenopathy (cN0). We sought to analyze trends in the utilization of early rND as well as assess factors associated with its use and survival outcomes using a nationwide cancer registry database. PATIENT AND METHODS The National Cancer Database was queried for patients with clinically nonmetastatic penile carcinoma and available nodal status who underwent rND from 1998 to 2012. Temporal trends in the utilization of early rND for those with cN0 disease were analyzed, and a multivariable logistic regression model was used to identify predictors for receiving rND. Survival analysis based on rND status was performed using the Kaplan-Meier method and Cox proportional hazard regression. RESULTS From 1919 patients with available clinicopathologic variables, performance of early rND was documented in 377 (19.6%) patients with an increase in utilization over time (P = .001). The increase was driven by academic and comprehensive cancer programs compared with community programs (P < .001). Positive predictors were treatment facility, clinical tumor stage, and grade (all P < .05). African American patients (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.33-0.86; P = .01) and those aged > 75 years (OR, 0.42; 95% CI, 0.26-0.68; P < .001) were significantly less likely to receive rND. Early rND was associated with improved overall survival (hazard ratio [HR], 0.67; 95% CI, 0.52-0.87; P = .003). CONCLUSION There was increased use of early lymphadenectomy for patients with cN0 penile cancer driven by comprehensive and academic cancer programs. The study demonstrated demographic and socioeconomic differences that can help identify barriers to care for patients with penile cancer in the United States.
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Affiliation(s)
- Juan Chipollini
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL
| | - Dominic H Tang
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL
| | - Pranav Sharma
- Department of Urology, Texas Tech University Health Science Center, Lubbock, TX
| | - Adam S Baumgarten
- Department of Urology, University of South Florida, Morsani College of Medicine, Tampa, FL
| | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL.
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12
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Management of Penile Cancer. Urology 2016; 96:15-21. [DOI: 10.1016/j.urology.2015.12.041] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 12/14/2015] [Accepted: 12/22/2015] [Indexed: 12/17/2022]
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Affiliation(s)
- Mahmoud Ziada
- Department of Urology, University College London Hospital, UK
- Department of Dermatology, University College London Hospital, UK
| | | | - Asif Muneer
- Department of Urology and NIHR Biomedical Research Centre, University College London Hospital, UK
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14
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Erythroplasia of Queyrat treated by laser and light modalities: a systematic review. Lasers Med Sci 2016; 31:1971-1976. [DOI: 10.1007/s10103-016-2005-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/16/2016] [Indexed: 10/21/2022]
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Lucky M, Murthy KV, Rogers B, Jones S, Lau MW, Sangar VK, Parr NJ. The treatment of penile carcinomain situ(CIS) within a UK supra-regional network. BJU Int 2014; 115:595-8. [DOI: 10.1111/bju.12878] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Marc Lucky
- Wirral University Teaching Hospital NHS Foundation Trust; Wirral Merseyside UK
| | | | - Beverley Rogers
- Wirral University Teaching Hospital NHS Foundation Trust; Wirral Merseyside UK
| | - Stephen Jones
- Wirral University Teaching Hospital NHS Foundation Trust; Wirral Merseyside UK
| | - Maurice W. Lau
- The Christie NHS Foundation Trust, Withington; Manchester UK
| | - Vijay K. Sangar
- The Christie NHS Foundation Trust, Withington; Manchester UK
| | - Nigel J. Parr
- Wirral University Teaching Hospital NHS Foundation Trust; Wirral Merseyside UK
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Yasuda M, Tamura A, Shimizu A, Takahashi A, Ishikawa O. Bowen's Disease Involving the Urethra. J Dermatol 2014; 32:210-3. [PMID: 15863869 DOI: 10.1111/j.1346-8138.2005.tb00747.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2004] [Accepted: 10/12/2004] [Indexed: 11/30/2022]
Abstract
Bowen's disease developing on mucous or mucocutaneous regions is clinically called erythroplasia of Queyrat. We report herein a 56-year-old male with Bowen's disease extending from the penis shaft to the glans penis, and urethral meatus. Physical examination revealed bright red velvety plaques on the prepuce and glans penis and an irregularly pigmented scaly lesion on the dorsum of his penis shaft. Histopathological findings of both lesions were compatible with those of Bowen's disease, supporting the concept that erythroplasia of Queyrat and Bowen's disease should be regarded as one clinicopathologic entity. A partial penectomy was finally performed, because tumor cells were pathologically observed in the mucous epithelium of the urethra. Although several therapeutic modalities exist for Bowen's disease on the external genitalia, treatment options are limited when Bowen's disease extends to the urethral meatus. We discussed the recent therapeutic modalities in genital Bowen's disease.
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Affiliation(s)
- Masahito Yasuda
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Edwards SK, Bunker CB, Ziller F, van der Meijden WI. 2013 European guideline for the management of balanoposthitis. Int J STD AIDS 2014; 25:615-26. [DOI: 10.1177/0956462414533099] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 03/16/2014] [Indexed: 01/13/2023]
Abstract
Balanoposthitis can be caused by a disparate range of conditions affecting the penile skin. This guideline concentrates on a selected group of conditions and offers recommendations on the diagnostic tests and treatment regimens needed for the effective management of balanoposthitis.
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Affiliation(s)
- SK Edwards
- Department of Genitourinary Medicine, Cambridgeshire Community Services, Bury St Edmunds, UK
| | - CB Bunker
- Department of Dermatology, University College Hospital, London, UK
| | - Fabian Ziller
- Department of Dermatology, DRK Hospital Chemnitz-Rabenstein, Chemnitz, Germany
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Bozzini G, Colin P, Betrouni N, Nevoux P, Ouzzane A, Puech P, Villers A, Mordon S. Photodynamic therapy in urology: what can we do now and where are we heading? Photodiagnosis Photodyn Ther 2012; 9:261-73. [PMID: 22959806 DOI: 10.1016/j.pdpdt.2012.01.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 01/23/2012] [Accepted: 01/24/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) is an innovative technique in oncologic urology. Its application appears increasingly realistic to all kind of cancers with technological progress made in treatment planning and light delivery associated with the emergence of novel photosensitizers. The aim of this study is to review applications of this technique in urology. MATERIALS AND METHODS We reviewed the literature on PDT for urological malignancies with the following key words: photodynamic therapy, prostate cancer, kidney cancer, urothelial cancer, penile cancer and then by cross-referencing from previously identified studies. RESULTS Focal therapy of prostate cancer is an application of PDT. Clinical studies are ongoing to determine PDT efficacy and safety. PDT as salvage treatment after radiotherapy has been tested. Oncologic results were promising but important side effects were reported. Individual dosimetric planning is necessary to avoid toxicity. PDT was tested to treat superficial bladder carcinoma with promising oncologic results. Serious side effects have limited use of first photosensitizers generation. Second generation of photosensitizer allowed reducing morbidity. For upper urinary tract carcinoma and urethra, data are limited. Few studies described PDT application in penile oncology for conservative management of carcinoma in situ and premalignant lesions. For renal cancer, PDT was only tested on preclinical model despite of its potential application. No data is available concerning PDT application for testicular cancer. CONCLUSION PDT clinical applications in urology have proved a kind of efficiency balanced with an important morbidity. Development of new photosensitizer generations and improvement in illumination protocols should permit to decrease side effects.
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Affiliation(s)
- G Bozzini
- Department of Urology, Centre Hospitalier Regional Universitaire de Lille, avenue oscar lambret, Lille, France. bozzini
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Abstract
Diagnosing premalignant penile lesions from benign penile dermatoses presents a unique challenge. The rarity of these conditions and the low incidence of penile cancer mean that the majority of our knowledge is based on small, non-randomized, retrospective studies. The introduction of specialist penile cancer centres in the UK has resulted in the centralization of expertise and resources, and has furthered our understanding of the biological behaviour and management of this rare malignancy. We review the current trends in the approach to diagnosing and treating various premalignant penile conditions.
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Affiliation(s)
- Majid Shabbir
- Department of Andrology, Institute of Urology, University College London Hospital, London, UK
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Fai D, Romano I, Cassano N, Vena GA. Methyl-aminolevulinate photodynamic therapy for the treatment of erythroplasia of Queyrat in 23 patients. J DERMATOL TREAT 2011; 23:330-2. [PMID: 21888568 DOI: 10.3109/09546634.2011.577405] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Erythroplasia of Queyrat (EQ) is an intraepithelial squamous cell carcinoma localized on the mucosal or transitional surfaces. Standard therapy usually consists of the surgical removal of the cancer. The use of non-invasive alternative procedures, such as photodynamic therapy (PDT), has been considered for the treatment of EQ, although only a few reports regarding isolated cases or small series exist. We describe our cumulative experience with PDT, using topical methyl-aminolevulinate (MAL), for the management of 23 male patients with EQ of the glans penis and/or prepuce. Patients underwent two consecutive weekly MAL-PDT sessions, with the second session postponed in seven patients because of an excessive local reaction. Nineteen patients obtained a complete clinical remission without any sign of recurrence over an average post-treatment period of 18 months (range, 8-30 months). Cosmetic outcome was excellent in most patients, while dyschromic changes occurred in four cases. All patients experienced transient local adverse reactions and 22 of them reported severe or very severe symptoms during the session.
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Affiliation(s)
- Dario Fai
- Phototherapy Unit Dermatology Service, AUSL LECCE, Gagliano del Capo, Salento, Italy
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Abstract
This article reviews melanoma and nonmelanoma cutaneous malignancies.
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Shabbir M, Muneer A, Kalsi J, Shukla CJ, Zacharakis E, Garaffa G, Ralph D, Minhas S. Glans Resurfacing for the Treatment of Carcinoma In Situ of the Penis: Surgical Technique and Outcomes. Eur Urol 2011; 59:142-7. [DOI: 10.1016/j.eururo.2010.09.039] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2010] [Accepted: 09/28/2010] [Indexed: 11/24/2022]
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Feldmeyer L, Krausz-Enderlin V, Töndury B, Hafner J, French LE, Hofbauer GF. Methylaminolaevulinic Acid Photodynamic Therapy in the Treatment of Erythroplasia of Queyrat. Dermatology 2011; 223:52-6. [DOI: 10.1159/000330328] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 05/31/2011] [Indexed: 11/19/2022] Open
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Minhas S, Manseck A, Watya S, Hegarty PK. Penile cancer--prevention and premalignant conditions. Urology 2010; 76:S24-35. [PMID: 20691883 DOI: 10.1016/j.urology.2010.04.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 04/09/2010] [Accepted: 04/09/2010] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Relatively little evidence is available in the published studies on the prevention of penile cancer and premalignant conditions of the penis. The present review examined the current evidence available in preventing penile cancer and pathologic subtypes of premalignant conditions and their treatment. The recommendations made in the present review formulate the basis of the recent 2009 International Consultation on Urologic Disease Consensus Publishing Group. METHODS The association of human papillomavirus subtypes and penile cancer is well-established, although the etiology, natural history, and treatment of premalignant lesions have mainly been reported in retrospective case series with short-term follow-up. The exact pathologic role of chronic inflammatory conditions, such as balanitis xerotica obliterans in the etiology of penile cancer remains largely unknown. RESULTS Some of the potential strategies for the prevention of penile cancer could include circumcision, reducing the risk of transmission of penile human papillomavirus infection with male vaccination, early treatment of phimosis, smoking cessation, and hygienic measures. Implementing some of these measures would require extensive cost/benefit analysis, with significant changes in the global health policy. CONCLUSIONS Owing to the current levels of evidence from published studies, firm guidelines cannot be formulated for the treatment of premalignant conditions, although preventative measures, such as reducing human papillomavirus transmission, could become strategic health targets.
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Affiliation(s)
- Suks Minhas
- Institute of Urology, Division of Surgical and Interventional Sciences, University College London, 25 Grafton Way, London, United Kingdom.
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Choi JW, Choi M, Cho KH. A case of erythroplasia of queyrat treated with imiquimod 5% cream and excision. Ann Dermatol 2009; 21:419-22. [PMID: 20523838 DOI: 10.5021/ad.2009.21.4.419] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 05/22/2009] [Accepted: 05/25/2009] [Indexed: 11/08/2022] Open
Abstract
Imiquimod is a new immunomodulating agent with antitumor and antiviral properties that has been shown to be clinically effective in various kinds of skin diseases, including precancerous dermatoses. Erythroplasia of Queyrat is a carcinoma in situ that mainly occurs on the glans penis. There are several non-invasive treatment options for erythroplasia of Queyrat such as photodynamic therapy, cryosurgery and applying various kinds of topical agents. We now report a case of typical erythroplasia of Queyrat on glans penis associated with human papillomavirus type 16 infection that was treated by imiquimod 5% cream and the subsequent excision of an imiquimod-resistant penile lesion.
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Affiliation(s)
- Jee Woong Choi
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
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Abstract
Radiation therapy is an important option for the treatment of skin cancer. Its advantages are preserving normal tissues, noninvasive outpatient treatment, and no need for anesthesia. Radiation therapy is used for deeper and extensive tumor and anatomic sites where it is difficult to obtain clear surgical margins. Radiation therapy is used as adjuvant treatment of patients who have positive surgical margins, perineural invasion, or regional node metastasis. It is useful for elderly patients who are unwilling or unable to undergo surgery. Radiation therapy is an effective treatment in eradicating gross and microscopic skin cancer, with a 5-year cure rate of 90% to 95%.
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Axcrona K, Brennhovd B, Alfsen GC, Giercksky KE, Warloe T. Photodynamic therapy with methyl aminolevulinate for atypial carcinoma in situ of the penis. ACTA ACUST UNITED AC 2008; 41:507-10. [PMID: 17853049 DOI: 10.1080/00365590701428590] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Photodynamic therapy (PDT) has been investigated as an alternative treatment for cutaneous squamous cell carcinoma in situ (CIS), also known as Bowen's disease. Atypia of the squamous epithelium is graded, with the most severe atypia being equivalent to CIS. CIS on the penis is regarded as a premalignant condition and is seen either in isolation or in conjunction with carcinoma of the penis. MATERIAL AND METHODS A group of 10 patients with atypia/CIS were treated with PDT between December 2002 and April 2005. The group consisted of five patients with primary lesions and five with atypia after an organ-preserving operation for carcinoma of the penis. RESULTS Eight patients were treated once, one twice and one six times. When complete remission was not achieved, a biopsy was taken for diagnosis. Three of the 10 patients had histopathological residual disease after a median follow-up period of 20 months (range 15-36 months). The first week after treatment could be painful but the cosmetic results were excellent. There was almost no loss of substance or fibrosis in the treated area, and sensitivity was restored to normal after approximately 1 month. CONCLUSIONS In our experience, PDT for CIS seems to be a promising treatment modality with regard to cancer control, organ preservation, cosmetics and functional results. As with laser therapy of these lesions, careful follow-up is mandatory. Larger studies are needed and are planned.
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Affiliation(s)
- Karol Axcrona
- Department of Surgical Oncology, Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway.
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Erythroplasia of Queyrat of the glans penis on a background of Zoon's plasma cell balanitis. Australas J Dermatol 2008; 49:103-5. [DOI: 10.1111/j.1440-0960.2008.00440.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Micali G, Nasca MR, Innocenzi D, Schwartz RA. Penile cancer. J Am Acad Dermatol 2006; 54:369-91; quiz 391-4. [PMID: 16488287 DOI: 10.1016/j.jaad.2005.05.007] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2004] [Revised: 03/30/2005] [Accepted: 05/03/2005] [Indexed: 11/24/2022]
Abstract
UNLABELLED Penile cancer, while relatively rare in the western world, remains a disease with severe morbidity and mortality, not to mention significant psychological ramifications. Furthermore, the disease is observed with dramatically increased incidence in other parts of the world. A review of the literature has shown that the overwhelming majority of penile cancers are in situ or invasive squamous cell carcinomas, including a well-differentiated variant, verrucous carcinoma. Important predisposing factors are lack of circumcision, human papillomavirus infections, and penile lichen sclerosus, although other factors have occasionally been reported as well. Prevention, careful monitoring of patients at risk, and early diagnosis are essential to reduce the incidence of penile carcinoma and to provide a definitive cure. Public health measures, such as prophylactic use of circumcision, have proved successful but are controversial. Also, no standard therapeutic guidelines as to the best treatment strategy according to different stages, including efficacy of conservative nonsurgical modalities and indications for lymph nodal dissection, are available so far. It is common opinion that penile cancer is an emerging problem that deserves further investigations, and physicians, especially dermatologists, should be aware of this issue. LEARNING OBJECTIVE At the completion of this learning activity, participants should be familiar with penile carcinoma, its risk factors, its clinical and histologic presentation, and the treatments currently available for its management.
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Affiliation(s)
- Giuseppe Micali
- Department of Dermatology, University of Catania School of Medicine, Catania, Italy.
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Del Losada JP, Ferré A, San Román B, Vieira V, Fonseca E. Erythroplasia of Queyrat with urethral involvement: treatment with carbon dioxide laser vaporization. Dermatol Surg 2006; 31:1454-7. [PMID: 16416620 DOI: 10.2310/6350.2005.31217] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Erythroplasia of Queyrat is an uncommon carcinoma in situ that usually arises on the mucosa of the glans penis or prepuce as red, shiny, sharply demarcated velvety plaques. The treatment is often difficult and associated with significant recurrence rates, especially in cases with urethral involvement. OBJECTIVE To evaluate carbon dioxide laser treatment in a case of erythroplasia of Queyrat with urethral involvement. MATERIALS AND METHODS We report a patient with erythroplasia of Queyrat involving the urethra who was treated with carbon dioxide laser vaporization. RESULTS Treatment with carbon dioxide laser vaporization resulted in an excellent cosmetic and functional status outcome for the glans penis and urethral lesions. CONCLUSION Carbon dioxide laser vaporization is probably the initial elective treatment for erythroplasia of Queyrat with urethral involvement in young immunocompetent patients. A follow-up is necessary, and new sessions of treatment should be quickly performed if recurrence occurs.
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Erythroplasia of Queyrat with Urethral Involvement. Dermatol Surg 2005. [DOI: 10.1097/00042728-200511000-00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lukas VanderSpek LA, Pond GR, Wells W, Tsang RW. Radiation therapy for Bowen’s disease of the skin. Int J Radiat Oncol Biol Phys 2005; 63:505-10. [PMID: 16168842 DOI: 10.1016/j.ijrobp.2005.02.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2004] [Revised: 02/15/2005] [Accepted: 02/15/2005] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the clinical outcome in the radiation therapy (RT) of squamous carcinoma in situ of the skin (Bowen's disease). We focused on the local control rate and the toxicity according to the biologically effective dose (BED). METHODS AND MATERIALS A retrospective review was performed on 44 patients with Bowen's disease treated at Princess Margaret Hospital from April 1985 to November 2000. RT was the primary treatment for 32 patients, whereas 12 received RT for residual disease after local ablative therapy. Lesions were located as follows: scalp, 9 patients (20%); face, 12 (27%); trunk, 6 (14%), extremity, 12 (27%), perianal, 3 (7%), and penis, 2 (5%). Orthovoltage X-rays were used in the majority (39 of 44, 89%). There was no standard fractionation regimen: some physicians prescribed high doses, as for invasive skin cancer, whereas others prescribed lower doses because of the noninvasive nature of the disease, a sensitive anatomic location (e.g., extremity), or large treatment area. Because of the variations in fractionation regimens, BED was used as a common metric for biologic effect in the comparison of different regimens and analyzed for correlation with recurrence and toxicity. Local control was defined as the lack of persistent or recurrent disease at the treated site for the follow-up period. Grade 4 toxicity was defined as necrosis (cartilage/bone damage) and/or ulceration for a duration of >3 months. RESULTS The mean patient age was 67.7 years, and the male/female ratio was 29:15. The median pretreatment lesion size was 2.65 cm(2) (range, 0.07-34.56 cm(2)). Complete remission was achieved in 42 patients, with follow-up unavailable for the remaining 2 patients. Subsequently, 3 patients experienced recurrences at 0.2, 1.1, and 1-1.5 years after complete remission. One recurrence was Bowen's disease (local); the others were squamous cell carcinoma (one local, one marginal). Four patients experienced a new squamous lesion at a distant cutaneous site. As of last follow-up, 32 patients (73%) were known to be alive. Median follow-up was 2.6 years (range, 0-11.8 years). All but 3 patients were disease-free at last follow-up, 1 of whom died with distant, but not local disease. The 5-year overall survival rate was 68%. Biologically effective dose was not associated with recurrence. The crude local control rate was 93%. There was a trend toward higher radiation doses for smaller pretreatment tumor and field sizes. The BED did not correlate with Grade 4 toxicity; however, the three cases of Grade 4 toxicity occurred in patients treated with hypofractionated regimens (dose per fraction >4 Gy) for extremity lesions. CONCLUSIONS Radiation therapy is an effective treatment option for Bowen's disease of the skin. Local recurrences seem to be equally low in patients treated with high- and low-dose regimens. Avoiding hypofractionated regimens (dose per fraction >4 Gy) in extremity locations might reduce the risk of Grade 4 toxicity.
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Affiliation(s)
- Lauren A Lukas VanderSpek
- Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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36
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Invasive Penile Carcinoma. Dermatol Surg 2004. [DOI: 10.1097/00042728-200402002-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND Penile carcinoma is an invasive epithelial tumor that may arise from penile skin or mucosa. OBJECTIVE To review the pathogenesis and the clinical and histopathologic features of invasive penile carcinomas, with emphasis on current guidelines for their diagnosis and treatment. METHODS Information available from the authors' clinical experience, review articles, case reports, clinical trials, and in vitro research studies identified from a computerized literature search on MEDLINE database and from Meetings' Abstract Books, including those from non-English literature, was considered. RESULTS Penile cancer may develop de novo or in association with underlying factors. Conditions predisposing to the development of penile cancer are delineated. The diagnosis should be suspected by clinical findings and must be confirmed histologically. Imaging techniques may be useful for staging and planning therapy. Therapeutic options include excisional surgery, laser destruction, cryosurgery, radiotherapy, immunotherapy, and chemotherapy. CONCLUSIONS Although there are no current guidelines for the treatment of penile carcinoma, surgical ablation probably represents the best option, as conservative treatments still deserve cautious evaluation because of the relatively small number of treated patients and the lack of good-quality comparative data. Regarding indications for lymph nodal dissection in patients showing no inguinal node enlargement, sentinel node mapping with targeted lymph node dissection is recommended for those with deeply invasive, high-grade tumors, whereas a watchful waiting may be advised for those with superficially invasive, low-grade tumors.
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Affiliation(s)
- Giuseppe Micali
- Dermatology Clinic, University of Catania Dermatology Clinic, University La Sapienza of Rome Department of Dermatology, New Jersey Medical School, Newark, New Jersey, USA.
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Arlette JP, Trotter MJ. Squamous cell carcinoma in situ of the skin: History, presentation, biology and treatment. Australas J Dermatol 2004; 45:1-9; quiz 10. [PMID: 14961900 DOI: 10.1111/j.1440-0960.2004.00025.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Squamous cell carcinoma in situ (SCCIS) of the skin is a problem commonly dealt with by dermatologists. The classic presentation, originally described by Bowen, is easily recognized, but presentation on some anatomical surfaces may be associated with less than typical features. Major aetiological factors for this disease are UV light, human papillomavirus infection and immunosuppression. The natural course of SCCIS is usually prolonged, with treatment being appropriate, but not urgent. The choice of therapy requires consideration of the location of the lesion, and a desire for a high cure rate without causing loss of form, function or cosmesis. The immunomodulatory agent imiquimod has offered a significant advance for the topical treatment of SCCIS. Our improved understanding of the underlying biology of SCCIS permits us to make rational choices of treatment. In the future we may be able to determine which of these lesions may progress to invasive disease, and help us select the most effective therapy.
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Affiliation(s)
- John P Arlette
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada.
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39
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Abstract
Bowen's disease of the skin may have differing clinical presentations depending on the skin surface on which it presents, but has the same histologic features of squamous cell carcinoma in situ wherever it occurs. The etiologic factors include ultraviolet light and human papillomavirus infection. The choice of therapy requires a consideration for retention of form, function and cosmosis while offering a high cure rate. The immunodualtory agent imiquimod has been shown to be an effective treatment on a variety of skin surfaces.
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40
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Danielsen AG, Sand C, Weismann K. Treatment of Bowen's disease of the penis with imiquimod 5% cream. Clin Exp Dermatol 2003; 28 Suppl 1:7-9. [PMID: 14616803 DOI: 10.1046/j.1365-2230.28.s1.3.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We present a case of persistent and progressive Bowen's disease (squamous cell carcinoma in situ) of the penis, in an otherwise healthy 56-year-old man. Treatment with imiquimod 5% cream was effective when applied once a day for 3 consecutive days followed by 4 days without treatment, over a period of 5 weeks.
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Affiliation(s)
- A G Danielsen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.
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41
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Hamid R, Shergill I, Arya M, Patel HRH. Penile cancer: an overview. HOSPITAL MEDICINE (LONDON, ENGLAND : 1998) 2002; 63:718-21. [PMID: 12512197 DOI: 10.12968/hosp.2002.63.12.1892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Carcinoma of the penis affects 1 in 100,000 men per year in most developed countries. It accounts for less than 1% of adult malignancies in Europe and the USA. Survival is excellent if diagnosed early, but most men present up to 1 year after the initial lesion is noted. Unfortunately the treatment of metastatic disease is still disappointing.
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Affiliation(s)
- R Hamid
- Institute of Urology, London W1W 7EY
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Pow-Sang MR, Benavente V, Pow-Sang JE, Morante C, Meza L, Baker M, Pow-Sang JM. Cancer of the penis. Cancer Control 2002; 9:305-14. [PMID: 12228756 DOI: 10.1177/107327480200900405] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Cancer of the penis is an uncommon malignancy in developed countries, but the incidence is as high as 17% of all male cancers in some undeveloped countries. The surgical management of this disease has improved due to better knowledge of risk for metastasis and newer imaging technologies to assess the regional lymph nodes. METHODS We review the literature on incidence, etiology, pathology, clinical presentation, staging, and management of penile cancer. We present our institutional experience with 160 patients who underwent extended ilioinguinal lymph node dissection, as well as with 7 patients who underwent a modified lymph node dissection. RESULTS Better understanding of pathologic features allow for stratification of patients into low, intermediate, or high risk for lymph node involvement. Lymphatic mapping to this stratification improves selection of patients who might benefit from lymph node dissection after excision of the primary lesion. Our experience with lymph node dissection yielded a high incidence of positive lymph nodes when lymphadenopathy was present. The recent use of a modified lymph node dissection has minimized morbidity. Current chemotherapy agents are ineffective in this disease. CONCLUSIONS Pathologic features of the primary lesion and the incorporation of lymphatic mapping have improved the selection of patients who might benefit from lymph node dissection. The use of a modified lymph node dissection in selected patients has decreased morbidity. Effective chemotherapy agents are needed in the management of advanced penile cancer.
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Affiliation(s)
- Mariela R Pow-Sang
- Department of Urology, Instituto de Enfermedades Neoplasicas Dr Eduardo Caceres Graziani, Lima, Peru.
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von Krogh G, Horenblas S. Diagnosis and clinical presentation of premalignant lesions of the penis. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY. SUPPLEMENTUM 2001:201-14. [PMID: 11144899 DOI: 10.1080/00365590050509931] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Although a considerable number of penile cancers may arise de novo, certain potentially premalignant conditions do exist. We account in some detail for precancerous growths, which may initially be misclassified and not submitted to proper therapy and follow-up. At one end of the spectrum disorders exist that are generally considered as medically benign, such as warty tumors; at the other end growths occur that are highly indicative of being potentially invasive, i.e. giant condylomas, bowenoid papulosis, eythroplasia of Queyrat and Bowen's disease. We also focus on elucidating the clinical behavior of some inflammatory conditions, which may either be of pathogenic significance for squamous cell carcinoma development or give rise to differential diagnostic problems, most importantly lichen sclerosus et atrophicus (balanitis xerotica obliterans). We advocate a vigilant approach for histopathological evaluation whenever any clinical diagnostic uncertainty or therapeutic recalcitrance exists. We also favor the administration of highly active topical therapy against penile chronic inflammatory conditions such as lichen sclerosus et atrophicus, careful clinical follow-up of these cases and surgical treatment of phimosis.
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Affiliation(s)
- G von Krogh
- Department of Dermatovenereology, Karolinska Hospital, Stockholm, Sweden.
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45
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Wieland U, Jurk S, Weissenborn S, Krieg T, Pfister H, Ritzkowsky A. Erythroplasia of queyrat: coinfection with cutaneous carcinogenic human papillomavirus type 8 and genital papillomaviruses in a carcinoma in situ. J Invest Dermatol 2000; 115:396-401. [PMID: 10951274 DOI: 10.1046/j.1523-1747.2000.00069.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Erythroplasia of Queyrat is a carcinoma in situ that mainly occurs on the glans penis, the prepuce, or the urethral meatus of elderly males. Up to 30% progress to squamous cell carcinoma. The cause of erythroplasia of Queyrat is largely unknown. Human papillomavirus type 16 DNA has previously been detected only in very few distinctly characterized patients. We have investigated 12 paraffin-embedded biopsies from eight patients with penile erythroplasia of Queyrat and control biopsies of inflammatory penile lesions, of genital Bowen's disease, and of premalignant/malignant cervical or vulvar lesions by 10 different polymerase chain reaction protocols for the presence of cutaneous and genital/mucosal human papillomaviruses. Human papillomavirus typing was performed by sequencing (cloned) polymerase chain reaction products. Human papillomavirus DNA was detected in all erythroplasia of Queyrat patients and in none of the controls with inflammatory penile lesions. The rare cutaneous carcinogenic epidermodysplasia verruciformis-associated human papillomavirus type 8 was present in all erythroplasia of Queyrat patients and the genital high-risk human papillomavirus type 16 in seven of eight patients (88%). In addition to human papillomavirus type 8 and human papillomavirus type 16, four patients carried the genital carcinogenic human papillomavirus type 39 and/or type 51. All human papillomavirus type 8 sequences found in erythroplasia of Queyrat showed some polymorphism among each other and differed in specific nucleotide exchanges from the human papillomavirus type 8 reference sequence. Viral load determinations (human papillomavirus copies/beta-globin gene copies) by realtime polymerase chain reactions showed that the human papillomavirus type 16 levels in the erythroplasia of Queyrat biopsies were one to five orders of magnitude higher than the human papillomavirus type 8 levels. Human papillomavirus type 8 was not detected in cervical or vulvar precancerous and cancerous lesions and in Bowen's disease lesions that carried genital human papillomavirus types. The data suggest that in erythroplasia of Queyrat, in contrast to other genital neoplasias, a coinfection with human papillomavirus type 8 and carcinogenic genital human papillomavirus types occurs. The presence or absence of human papillomavirus type 8 might help to distinguish between penile erythroplasia of Queyrat and Bowen's diseases.
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Affiliation(s)
- U Wieland
- Institute of Virology, University of Köln, Köln, Germany.
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Petter G, Haustein UF. Histologic subtyping and malignancy assessment of cutaneous squamous cell carcinoma. Dermatol Surg 2000; 26:521-30. [PMID: 10848931 DOI: 10.1046/j.1524-4725.2000.99181.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Squamous cell carcinomas (SCCs) of the skin have a wide range of histologic subtypes and there are indications of differences in prognosis. OBJECTIVE The morphologic variety of SCCs with respect to its biological behavior and the further course of disease is analyzed, with emphasis on histopathologic criteria, briefly quoting the main clinical and pathogenetic aspects. METHODS Referring to the international tumor classification of the World Health Organization, histologically different carcinoma variants are presented and discussed, based on a review of the literature regarding each subtype, and also including the desmoplastic SCC type. RESULTS Histologically, common invasive SCCs are most frequently found, while metastases mainly occur in tumors of high thickness and poor differentiation. The immature spindle cell carcinoma type resembles sarcoma and may grow rapidly with an aggressive clinical course. Lymphoepithelioma-like carcinoma of the skin is extremely rare and its histogenesis remains to be elucidated. Thus far, one case with metastasis and lethal outcome has been reported. As details determining the progression ability have so far only been scanty and partially contradictory, more investigations are necessary, especially for acantholytic SCCs and invasive SCCs developing from Bowen's disease, whereas verrucous carcinomas can be categorized as low malignancy neoplasms. Desmoplastic SCCs, especially with large tumor thickness, should be separated from other SCC subtypes due to their high risk of local recurrence and metastatic spread. CONCLUSION The future outcome of SCCs of the skin is significantly influenced by their histologic grade and tumor thickness. In addition, subtyping represents another valuable histopathologic tool for improving the assessment of malignancy.
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Affiliation(s)
- G Petter
- Department of Dermatology, University of Leipzig, Leipzig, Germany
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Varma S, Holt PJ, Anstey AV. Erythroplasia of queyrat treated by topical aminolaevulinic acid photodynamic therapy: a cautionary tale. Br J Dermatol 2000; 142:825-6. [PMID: 10792247 DOI: 10.1046/j.1365-2133.2000.03441.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cox NH, Eedy DJ, Morton CA. Guidelines for management of Bowen's disease. British Association of Dermatologists. Br J Dermatol 1999; 141:633-41. [PMID: 10583109 DOI: 10.1046/j.1365-2133.1999.03100.x] [Citation(s) in RCA: 137] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
These guidelines for management of Bowen's disease have been prepared for dermatologists on behalf of the British Association of Dermatologists. They present evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiological aspects, diagnosis and investigation.
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Affiliation(s)
- N H Cox
- Department of Dermatology, Cumberland Infirmary, Carlisle, CA2 7HY, U.K
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Griffiths TR, Mellon JK. Human papillomavirus and urological tumours: I. Basic science and role in penile cancer. BJU Int 1999; 84:579-86. [PMID: 10510097 DOI: 10.1046/j.1464-410x.1999.00271.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- T R Griffiths
- University Urology Unit, Freeman Hospital, Newcastle upon Tyne, UK
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50
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Stables GI, Stringer MR, Robinson DJ, Ash DV. Erythroplasia of Queyrat treated by topical aminolaevulinic acid photodynamic therapy. Br J Dermatol 1999; 140:514-7. [PMID: 10233277 DOI: 10.1046/j.1365-2133.1999.02720.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Erythroplasia of Queyrat (EQ) is an intraepithelial carcinoma in situ affecting the mucosal surfaces of the penis, with a significant risk of invasion and metastasis. Treatment is often difficult and is associated with significant recurrence rates. Topical 5-aminolaevulinic acid (ALA) photodynamic therapy (PDT) combines a photosensitizer precursor and visible light to produce a photodynamic effect. It has been used successfully to treat benign, premalignant and malignant skin diseases. We present four patients with EQ who have been treated by topical ALA PDT. Of two patients with limited disease one has achieved a long-term complete response (36 months) and the other developed a recurrence at 18 months after a complete response. Two further patients with more extensive disease achieved a significant improvement, allowing easier treatment by laser vaporization. Although topical ALA PDT offers the advantages of tumour specificity, preservation of function and a good cosmetic result, more extensive EQ appears less responsive to this new therapeutic modality using current treatment parameters.
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Affiliation(s)
- G I Stables
- Department of Dermatology, The General Infirmary at Leeds, Leeds LS1 3EX, U.K
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