Management of primary tumor in penile carcinoma

* Enrollment in a formal clinical trial is encouraged whenever possible. Refer to UpToDate content on management of penile carcinoma.
¶ Definitive surgery following neoadjuvant chemotherapy when feasible, otherwise palliative care.
Δ Tis involving shaft skin and glans penis, Ta lesion involving shaft skin or glans only, or T1a/T1b lesion involving the shaft skin glans alone.
◊ Bulky primary T2-T4 involving glans, corpora, or adjacent structures.
§ Limited excision is preferred and requires excision to negative margins. Other organ-preserving alternatives include topical therapy, laser ablation, total glans resurfacing, Mohs micrographic surgery, and radiation therapy.
¥ Careful surveillance is required because of the risk of local or regional recurrence.
‡ Penile amputation may require either partial or total removal of the penis, depending upon the location and extent of the primary tumor. Some patients with smaller lesions can be treated with more limited excision, as long as a tumor-free margin can be achieved.