Laser therapy of squamous cell dysplasia and carcinoma of the penis.

OBJECTIVES: To analyze the influence of etiologic factors and practical issues regarding the merits, limitations, and long-term results of aggressive laser treatment of premalignant and malignant squamous cell lesions of the penis.

METHODS: Preparation of genital skin with 5% acetic acid and mapping biopsies of lesions and the surrounding field-of-change were performed in 52 men evaluated and subsequently treated with laser during a 10-year period. Most men (81%) were or had been smokers, and many (46%) had female sexual partners infected with human papillomavirus. Carbon dioxide laser was used for low-stage lesions; potassium-titanylphosphate/532 or neodymium:yttrium-aluminum-garnet laser was used for more histologically advanced lesions. Not only the lesions but also the entire human papillomavirus-induced field-of-change was treated. Circumcision was performed simultaneously in 28 previously uncircumcised patients.

RESULTS: All lesions demonstrated aceto-whitening and histologic changes of human papillomavirus infection. Human papillomavirus DNA was detected in 93.5% of the specimens from 31 patients studied. Of the 52 patients, 22 (42%) had dysplastic premalignant penile intraepithelial neoplasia, and the remaining 30 (58%) had squamous cell carcinoma. Forty-four patients were available for follow-up from 12 to 117 months (average 58). Overall, 5 patients (11.4%) experienced a recurrence: 3 were successfully re-treated with laser, and 2 patients underwent partial penectomy, 1 of whom with squamous cell carcinoma Stage T2 died of metastatic disease.

CONCLUSIONS: Aggressive laser therapy of the visible lesions and of the entire dysplastic premalignant field-of-change produces excellent cosmetic results. The entire penis and, therefore, its full sexual functional potential are preserved. The low rate of local recurrence over the long term in all but deeply invasive (T2) lesions compares favorably with the outcome of other, more conventional therapies. Irrespective of therapeutic approach, close and long-term surveillance of all patients and counseling for their sexual partners are mandatory.