Treatment

Hi Dorsw welcome to the forum. I'm not sure if many people will know what it is that you are asking about and based on that I did a search and found information on the Cancer Research UK website which I have attached for you and it seems to go through the type of pre cancer that this is and what treatments might be beneficial.

 Clearly all of this information will be dependent on what the people treating this decide what is best for the individual. Hope thats of some help in the meantime. 

https://www.cancerresearchuk.org/about-cancer/penile-cancer/treatment/treatment-options

Hey Doris - new to this forum. But I was just diagnosed with squamous cell carcinoma (in situ) on the penile shaft (near the base). Specifically called Bowen's Disease. Small lesion, that was biopsied, and likely related to HPV, although, from what I understand no HPV was found in biopsy. I am 47.

From looking up "penile intraepithelial neoplasia" this is another terms for "in situ". Although you probably know this already, my doctor explained these are cancer cells limited to the upper layer (epidermis) of the skin, and have not move anywhere. It sounds like you're asking about the same thing.

I was given two options from primary urologist: wide excision (10mm) OR allow the biopsied site to heal and use imiquimod with continued observation. From what I understand (and from doctors explanation) this is very early (Stage 0) skin cancer, with extremely high cure rate if treated, but potentially very dangerous if not treated. 

I am seeing another doctor who specializes in Mohs surgery (another surgical option, but one that my primarily urologist doesn't offer), and because this specialist doctor has a published academic history of Bowen's disease. I am especially curious about wide excision margins (5mm vs. 10mm, etc.) as it's a big chunk of skin to remove from the penile shaft, I'm concerned about complications (and more superficially, cosmetics) - cancer & penis really do not sit well with the mind.

Anyway - if you'd like - I can let you know what this other specialist tells me regarding Mohs surgery, or any other suggestions he makes.

Take care

Hey Doris - as a follow up: saw a specialist in Bowen's / skin cancer this week. He gave me a lot more detail on this condition, as well as multiple options.

My case may be a bit different, as I had the lesion excised already (with about 2mm margin), but there were some "atypical cells" on the edges of the biopsy so we're looking at how to deal with these. Although specialist said that he's give the same options even if lesion was still present.

Also to mention - my initial diagonsis & biopsy was from urologist. But I went to specialist for 2nd opinion. Speciailist also ordered the biopsy be reanalyzed at another lab, as he wants a second opinion to be sure. I think everyone should ask for this if possible. He said misdiagnosis are possible, so he always orders another analysis. This is an associate prof. of dermatology with multi-decade history of treating skin cancer, with a lot of published papers and clinical trails of skin cancer treatment.

Here are the options he put on the table, with his disclaimers (paraphrasing from memory): 

 1) Mohs surgery. The gold standard. 100% clearance rate, since they analyze skin during surgery and continue to take tissue layers until no cancer cells are detected. Depending on size of lesion, this type of surgery may require skin grafting. But for surgery, this is the least invasive, with highest success rate, and preserves the most healthy tissue.

2) Wide excision, with 5-10mm margin. Most destructive, and leaves the potential that cancer cells with still show up on the edge of excision. This is most invasive approach, will leave a substantial scar, and many potential complications (infection, stitches ripping, painful scaring, etc.), and long recovery. To understand margins - a 10mm margin is measured from the center and all the around. So 10mm would be 20mm, but usually 3:1 ratio wide, as they make an ellipse (eye shape) in order to close the incision in a straight line. So a 10mm margin would potential equal 2x6cm of skin excised. Draw it on a piece of paper - it's substantial. Some recommend 5mm margin though, since success rates are very high (I believe 85%+ with 5mm margins). About ~95% with 10mm.

3) C02 Laser therapy (and I remember him mentioning pulsed-dye laser, but didn't recommend it). This is my specialists 1st recommendation. 5mm margin, and significant tissue destruction, but less scarring and downtime compared to surgical options. Very high success rate, but I did not get info on specific laser specs other than C02 laser (there are many options for this laser approach from my understanding)

4) Cryotherapy (freezing). Wide margin of 5mm +. Unsually local anesthetic. Long freezing time (40s?) Excellent cosmetic results, fairly quick recovery of skin...however, my doctor did not recommend this as he doesn't think success rates are high enough.

5) Curretage - scrabbing it off surgical tool. Shown as an option but not discussed. 

6) Immiquimod or Efudex cream. He highly recommended Efudex, with the disclaimer that these are both long treatments (2-6 weeks, then potentially month or longer recovery). He was clear that some patients stop using these in the first couple weeks because of significant inflammation, pain, irritation, etc. But he did say that it has very high rate of success. You can google Efudex reactions during treatment - they look horrirfying, but in every case I've seen the results look excellent. It's just the treatment phase looks like a horror movie. Ha.

So, that's what my doctor laid on the table for me. He really helped calm me down about this condition, as he's treated it for decades, with excellent rates of success, even in the genitals area.

In summary - his #1 recommendation for 100% clearance was Mohs surgery. Expensive. Long surgery. But total confirmed clearance when you leave the operating room. His #2 recommendation was C02 laser with wide margin. Best for quick recovery, and high success rate (although not 100%.). 3rd suggestion was Efudex (he didn't talk too much about immiquimod...but it seemed to be a part of the same recommendation. Long treatment phase, potential for major irritation / inflammation for weeks, but good success rate. He seemed to think this topical treatment was better after another treatment was preformed, just to deal with potential atypical cells left behind.

Hopefully some of this info helps. I really got lucky to see a specialist in this condition on short notice, and his info seemed invaluable.I liked that he ordered a second analysis of the biopsy. Seems smart considering the invasiveness of some of these treatments. Although I'm going for a 3rd opinion as well. Can't have enough info! :D 

Thanks for sharing these options. Any updates on what you decided?