Editing EAU & ASCO: Penile Cancer 2023 (section)

== Follow-up ==

=== Recurrence ===

* Local or regional nodal recurrences usually occur within 2-3 years of primary treatment
** Local recurrence is easily detected by physical examination, by the patient himself or his physician.
** Regional recurrence requires timely treatment by rILND with (neo)adjuvant chemotherapy/chemoradiotherapy.
* Follow-up also depends on the primary treatment modality
** Histology from the glans should be obtained to confirm disease-free status following laser ablation or topical chemotherapy
* After local treatment with negative inguinal nodes
** Follow-up should include physical examination of the penis and groins for local and/or regional recurrence. Additional imaging has no proven benefit

=== Lymphedema ===

* Following nodal surgery, ideally, refer to specialist lymphoedema services for assessment and management before any significant lymphoedema occurs.
** Specialist lymphoedema services offer a range of made-to-measure compression garments or multi-layer lymphoedema bandaging for lower limb and genital lymphoedema
* Assess for genital and lower limb lymphoedema at each outpatient clinic appointment
* Advise good skin care, compression, exercise, massage, and elevation when resting as the mainstay of treatment. 
** For lower limb compression adjustable Velcro garments also exist.
** Good skin care is critical to prevent infection that can damage remaining lymphatic channels.
** Prophylactic antibiotics should be used following any episode of cellulitis
*** Penicillin V, erythromycin or clindamycin recommended, except in genital lymphoedema where prophylactic trimethoprim can be used