Sebaceous Carcinoma Of The Penis

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 13 Sep 2009 - 0:00 PDT


UroToday.com - Sebaceous carcinoma may arise in ocular or extraocular sites and exhibit such a variety of histologic growth patterns and diverse clinical presentation that the diagnosis is often delayed for months to years. The histopathologic criteria for sebaceous carcinoma are high mitotic activity, nuclear pleomorphism, lobular architecture, and foamy vacuolization in the cytoplasm. Extraocular sebaceous carcinoma accounts for approximately 25% of all reported cases of sebaceous carcinoma. Clinically, the lesion presents as a firm nodule that ranges in size from 6mm to 20 cm. The mean age of presentation is 63 years, and there is an equal sex distribution.

Lesions can occur virtually in any parts of body that contain sebaceous glands, but the incidence is highest in the head and neck area in which sebaceous glands are most plentiful. The external genitalia is another reported site in which extraocular sebaceous carcinoma can occur.

Only 2 cases of sebaceous carcinoma were reported on the penis. Our series adds 3 additional cases involving the penis. The optimal treatment for sebaceous carcinoma of penis has not been established. Surgical resection with generous clear margin should be performed to avoid local recurrence but is associated with a rate of consequent regional lymphatic tumoral propagation. Dissection of the regional lymph nodes should be considered as adjuvant surgical treatment. The treatment is debatable in view of the fact that this kind of tumor has a high recurrence rate and early regional lymph node involvement. Considering these facts, we used preoperative lymphoscintigraphy, intraoperative lymph node mapping and sentinel node biopsy before performing a bilateral inguinal lymphadenectomy in 1 of 3 patients treated in our institute. In our case 2, despite the lymph nodes having had confirmed metastatic involvement, the patient is living 1 year after bilateral inguinal lymphadenectomy.

Sebaceous carcinoma of the penis is a very aggressive tumor with early lymph node involvement and early-disseminated metastases. Accurate diagnosis and staging are essential to proper treatment planning. Wide excision and systematic bilateral inguinal lymphadenectomy should be performed for locoregional control of the malignancy. Adjuvant radiotherapy and chemotherapy protocols should be established to treat patients with local recurrence and distant metastases.

Written by Antonio Augusto Ornellas MD, PhD as part of Beyond the Abstract on UroToday.com.

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