Mohs Micrographic Surgery for Penile Squamous Cell Carcinoma: A Systematic Review

BACKGROUND: Squamous cell carcinomas (SCCs) of the penis are often treated with partial or total penectomy. Although penectomy has low recurrence rates, it often leads to psychosocial distress and disfigurement. Mohs micrographic surgery (MMS) is a tissue-preserving treatment modality, but data on recurrence rates are limited and the National Comprehensive Cancer Network (NCCN) guidelines recommend it only for in situ and stage T1 tumors in select cases, based on the American Joint Committee on Cancer (AJCC) eighth edition staging criteria. OBJECTIVE: This study systematically reviews clinical studies on MMS for penile SCC, summarizing disease outcomes and surgical complications. METHODS: A systematic review was conducted using Ovid MEDLINE, Embase, Cochrane, CINAHL, and Web of Science for studies published through October 23, 2024. RESULTS: Nineteen studies with 329 penile SCCs met inclusion criteria. Local recurrence (n = 15, 5%), nodal metastasis (n = 8, 3%), distant metastasis (n = 1, 0.3%) and disease-specific death (n = 3, 1%) were rare. Urologic Surgery collaboration was utilized in 27% of cases, performing procedures including urethrectomy, meatotomy, and reconstruction. Complications occurred in 9%, including poor wound healing (n = 11, 3%), urethral stricture (n = 11, 3%), wound infection (n = 3, 1%), and bleeding (n = 2, 1%). Patients with advanced-stage (T2/T3) tumors had higher rates of local recurrence (8% vs 1%), and similar rates of nodal (2% vs 1%) and distant metastasis (0% vs 1%), compared to patients with early-stage tumors (Tis/T1). CONCLUSION: Mohs micrographic surgery is a penis-sparing surgical approach with low recurrence rates in low-stage tumors. Multidisciplinary collaboration with Urology is recommended in cases of advanced-stage tumors, anticipated reconstruction, or urethral involvement. Further research is needed, as the level of evidence was low in this systematic review.