Penile squamous cell carcinoma (PSCC) is a rare malignancy, accounting for <1% of newly diagnosed cancers globally every year with the lowest rates of 0.1–1 per 100,000 seen in high income countries and where neonatal circumcision is routine [1]. Approximately 85% present without evidence of regional or metastatic disease [2], indicating the importance of optimal management of the primary tumor. Local therapy options are expansive and can include topical therapies, photodynamic therapy, wide local excision, glansectomy, glans resurfacing and partial or radical penectomy. Decision-making for these options is dependent on patient anatomy, location and burden of local disease, and interventional goals [3]. Goals of management focus on complete resection to minimize local recurrence and need for further interventions and, importantly, organ preservation to maximize functional outcomes.

The ability to predict local recurrence and risk-stratify patients is unclear due to the rare nature of PSCC, lack of high-quality data, heterogenous presentations, and varied treatment options employed in localized disease. Local recurrence rates range from 4 to 18%. Previous reviews have identified risk factors for local recurrence following local management including: pT stage, grade, lymphovascular invasion (LVI), and penile preserving surgery [[4], [5], [6], [7], [8]].

The utilization of margin status to predict local recurrence has been particularly unclear. In penile-sparing cohorts, there have been conflicting results. In a large retrospective cohort undergoing organ sparing surgery, only positive margin status was independently associated with local recurrence [4,9]. However, this has not been demonstrated in other studies [6,10], including when stratifying by distance to margin [7]. The role of frozen margins during surgery to predict final margins is even less clear. A recent review found that use of frozen margin analysis resulted in a 0.6% final positive margin rate among 169 patients. However, the resultant local recurrence rate of 5.3% is similar to that of other studies not employing frozen section analysis [11]. Additionally, in a small comparative study, the use of frozen section analysis appeared to reduce positive final margins by > 50%, but there was no benefit in prevention of local recurrence [12].

In this study, we examine local recurrence patterns in patients undergoing partial and radical penectomy to evaluate clinical and pathologic predictors of local recurrence. Additionally, we explore the interaction between frozen and final margin status to identify patterns and clinical significance of recurrence.