Malignant changes have been noted in 12 of the approximately 100 reported cases, with such lesions exhibiting all of the characteristics of penile carcinomas. We believe that wide local excision should be the initial treatment, with deep biopsies of the skin surrounding the base of the lesion for accurate histological diagnosis. YAG laser therapy have been reported by many authors for condylomata acuminate. Large lesions usually require more than 1 treatment session but the lesser degree of scarring with superior cosmetic results make laser therapy attractive. Because of the size of these lesions, podophyllin effective against condylomata probably is not appropriate.
Circumcision is warranted to reduce the risk of recurrence.
If malignancy is found in the horn histologically, partial penectomy with or without regional lymph node dissection should be considered, as in any penile carcinoma. They reported on the use of this modality in 17 patients who refused conventional surgical therapy. Cosmetic results were excellent with only one local recurrence during a followup period of 11 to 39 months. Although these results are encouraging and primary laser therapy may prove to be the treatment of choice in selected cases, we believe that presently penectomy remains the preferred modality. W. B. Saunders Co., 1940.