CO₂ laser resection for preneoplastic and initially invasive neoplastic lesions of the penis: Indications and technique

Superficial resection of preneoplastic and initially invasive penile lesions by CO2 laser has been developed as an alternative treatment modality to traditional surgical and destructive methods. Hyperkeratosis, pigmented lesions, chronic inflammatory disease, erythroplasia of Queyrat, Bowenoid papulosis are the main diagnostic and therapeutic indications. Therapeutic resection is indicated for histologically proven penile intraepithelial neoplasia (PIN) grade II and III, and initially invasive squamous cell carcinoma. Conservative laser resection is also indicated for exophytic, superficially infiltrating T1NO squamous cell carcinoma, responsive to systemic chemotherapy. Laser excisional procedures are always performed in association with the operating microscope, under local anaesthesia, often on an outpatient basis. Based on the disease extent, partial or total glans surface resection can be performed or associated with circumcision. Surgical specimens are always adequate for histological examination as to the extent of the disease in depth and width. Uncleared margins of resection indicate the need for further treatment. Technical, anatomical, and functional results confirm the clinical effectiveness of this microsurgical approach for selected lesions.