T1 Lesions Confined to the Prepuce 631 Circumcision Wide Local Excision

Circumcision is by far the commonest operation in the surgical management of penile carcinoma, and is indicated for primary curative therapy in low-stage preputial disease.30 However, adequate clearance margins must be achieved. If the lesion is more extensive the excision may be extended onto the shaft skin or coronal sulcus as necessary.31,32 Circumcision is always recommended prior to radiotherapy, allowing for accurate targeting and tumor definition. It also aids surveillance for local recurrence.

Recurrence rates of up to 30% have been reported following circumcision,33,34 the majority of these occurring in the first 2 years following surgery.35 Close postoperative surveillance is therefore essential. However, salvage surgery has a high success rate and does not appear to affect the disease-specific survival.31,36 If CIS is present at the resection margin then this can be treated with topical 5% 5-FU or Imiquimod cream and then closely observed.

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