Treatment of Premalignant Penile Lesions

The non-invasive nature of premalignant lesions makes them amenable to curative penile preserving therapies. Before starting any treatment a biopsy should be performed in order to confirm the diagnosis and ensure that the lesion does not have any invasive elements. A number of different approaches can be utilized for premalignant lesions, depending on the size, site, and type of lesion. These approaches include the use of topical chemotherapy or immunotherapy, laser treatment, photo-dynamic therapy, and surgical excision. Due to the low number of patients treated in small studies, most of the recommendations for treatment are based on level III evidence.

Circumcision is an essential part of the management of premalignant conditions. As well as removing the lesion if confined solely to the prepuce, it also prevents persistence of an environment suited to HPV infection, chronic inflammation, and progression to invasive disease. It also facilitates follow-up and clinical examination, which is essential with minimally invasive approaches. When performing the circumcision, an adequate clearance margin must be achieved. In difficult cases, a swab soaked in 5% acetic acid applied to the penis for 2-3 min allows a more accurate detection of occult CIS. The abnormal areas are stained white ('acetowhite' reaction), and this can be used to guide the margins of excision.60

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