T1 Lesions on the Glans Penis

The management of these lesions remains controversial as several options are available. Careful case selection is important in order to ensure that low-risk tumors (i.e., T1 G1-2 in the absence of CIS) are differentiated from high-risk ones. Wide local excision (WLE) and primary closure may be possible if the lesion is discrete and not too close to the external meatus. For larger tumors, following WLE, a split thickness skin graft can be utilized to minimize distortion of the glans and reduce functional impairment. Complete excision is essential at the initial operation. However in some series, recurrence rates of up to 50% have been reported, most occurring in the first two postoperative years.37 Recurrent disease can be managed successfully with further surgery in most cases without compromising disease-specific survival.36,38 Close surveillance and patient education is vital for the early detection of relapse. Where there is coexisting CIS, topical chemotherapy with 5% 5-FU cream can be used. Again close follow-up is imperative.

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