Editing EAU & ASCO: Penile Cancer 2023 (section)

===== Surgical =====
* '''Pre-operative planning requires taking into consideration the''' 
** '''Size of the mass'''
** '''Involvement of surrounding structures'''
** '''Anticipated skin and soft tissue defects (as well as plastic surgical consultation (as appropriate))'''
* '''<span style="color:#ff0000">Organ-sparing'''
** '''<span style="color:#ff0000">Options (3)'''
**# '''<span style="color:#ff0000">Circumcision'''
**#* '''<span style="color:#ff0000">Standard treatment for foreskin/preputial penile cancer'''
**#* '''<span style="color:#ff0000">Facilitates follow-up in patients treated with topical treatment, laser therapy or brachytherapy, facilitates follow-up examinations'''
**# '''<span style="color:#ff0000">Wide local excision'''
**# '''<span style="color:#ff0000">Partial or total glansectomy, with or without reconstruction'''
**#* '''Glans resurfacing'''
**#** '''Consists of full thickness removal of the glandular epithelium followed by reconstruction with a graft'''
**'''<span style="color:#ff0000">Indications'''
***'''<span style="color:#ff0000">Lesions confined to the glans and prepuce (PeIN, Ta, T1–T2) and patient willing to comply with strict follow-up'''
* '''<span style="color:#ff0000">Amputative surgery (2)'''
*# '''<span style="color:#ff0000">Partial penectomy'''
*#* '''<span style="color:#ff0000">Indications'''
*#*# '''<span style="color:#ff0000">Invasion of the corpora cavernosa (T3)'''
*#*# '''<span style="color:#ff0000">Patient not willing to undergo organ-sparing surgery or not willing to comply with strict follow-up.'''
*#*Efficacy
*#**Risk of local recurrence ≈4–5%
*#'''<span style="color:#ff0000">Total penectomy with perineal urethrostomy'''
*#*'''<span style="color:#ff0000">Indications'''
*#**'''<span style="color:#ff0000">Large invasive tumours not amenable to partial amputation'''
* '''With surgical treatment, negative surgical margins for invasive carcinoma must be obtained.'''
** Width of negative surgical margin (macroscopic margins can indeed be minimal, specifically in smaller and less aggressive lesions)
*** Standard excision must include a margin of clinically normal-appearing skin around the tumour and surrounding erythema. However, for bulky or higher-grade lesions where local recurrence may have an impact on survival, adoption of a wider margin or partial penectomy may be prudent
** Perform intra-operative frozen section analysis of resection margins in cases of doubt on the completeness of resection.
*** Use of intra-operative frozen section assessment not routinely recommended
*** Helpful tool to achieve definitive tumour-free margin in cases of doubt on the radicality of the resection