Glans Resurfacing for PeIN & Penile Cancer
Glans resurfacing is an organ-preserving operation used for selected superficial abnormalities of the glans, particularly penile intraepithelial neoplasia (PeIN) and some carefully selected superficial penile cancers.
The abnormal surface tissue is removed while preserving the deeper structure of the glans, and the exposed surface is reconstructed, commonly using a skin graft.
What is glans resurfacing?
The glans is the head of the penis. Some precancerous and superficial cancerous abnormalities arise predominantly within its surface epithelium rather than deeply within the underlying erectile tissue.
Glans resurfacing removes the abnormal epithelial surface and a controlled layer of underlying superficial tissue while preserving the deeper glans.
A graft — commonly a thin skin graft — is then placed over the exposed surface to create a new covering.
Unlike treatments that destroy abnormal surface tissue, surgical resurfacing provides tissue for detailed pathological assessment across the treated area.
What is penile intraepithelial neoplasia?
Penile intraepithelial neoplasia, usually shortened to PeIN, describes abnormal precancerous cells confined to the epithelial surface of the penis.
It is not the same as invasive cancer
In PeIN, abnormal cells remain within the surface epithelium. Invasive penile cancer has penetrated into deeper tissue.
It still requires treatment and follow-up
PeIN has the potential to progress to invasive cancer, so persistent or biopsy-confirmed disease should not simply be ignored.
Several treatments may be possible
Depending on location and extent, management may include circumcision, topical treatment, laser treatment, local excision or glans resurfacing.
Who may be suitable for glans resurfacing?
Resurfacing is most useful when the abnormality is confined predominantly to the surface of the glans and preservation of the deeper glans is oncologically appropriate.
Situations can include:
- extensive PeIN affecting the glans
- recurrent PeIN following previous local treatment
- residual PeIN after previous therapy
- multifocal superficial disease
- selected superficially invasive tumours where organ-preserving treatment remains appropriate
- circumstances where obtaining a complete surgical specimen for pathological assessment is particularly useful
Resurfacing may not be appropriate when:
- disease clearly extends deeply into the glans
- the tumour involves deeper erectile structures
- adequate cancer clearance cannot be achieved while preserving the deeper glans
- pathology suggests a tumour requiring more extensive resection
- previous treatment or tissue quality makes graft reconstruction unsuitable
Penile preservation is considered when the tumour can still be treated adequately. The desire to preserve the glans should not compromise appropriate oncological treatment.
Establishing the diagnosis and depth of disease
A red, velvety, ulcerated or irregular area on the glans cannot reliably be diagnosed by appearance alone.
Assessment may include:
- clinical examination of the penis and glans
- assessment of the foreskin and urethral opening
- examination of both groins
- review of previous photographs or treatment history
- biopsy and pathology where required
- selected local imaging if deeper invasion is uncertain
The operation required for abnormal cells confined to the epithelial surface may be very different from treatment for a cancer that has invaded more deeply into the glans or erectile bodies.
From abnormal biopsy to organ-preserving treatment
Confirm pathology
Establish whether the lesion is PeIN, superficially invasive cancer or a deeper tumour.
Define extent
Determine how much of the glans is affected and whether deeper tissue appears involved.
Select treatment
Compare local treatment, resurfacing, glansectomy or another cancer operation.
Review final pathology
Confirm disease depth, margins and whether further treatment or staging is required.
How is glans resurfacing performed?
The precise technique depends on whether part or all of the glans surface requires treatment.
In broad terms, surgery involves removing the abnormal epithelial surface while leaving the deeper glans tissue in place.
Expose the glans
The glans is carefully exposed and the abnormal surface mapped.
Remove the surface
The affected epithelial layer and appropriate superficial tissue are removed for pathological examination.
Prepare the graft
A thin skin graft is commonly harvested from another area, often the thigh.
Resurface the glans
The graft is secured to the prepared glans surface and protected while it heals.
Partial or total glans resurfacing?
The amount of surface removed depends on the distribution of the abnormality and the ability to achieve appropriate treatment margins.
Partial glans resurfacing
Only the affected region of the glans surface is removed and reconstructed.
This may be considered when disease is clearly localised and an appropriate margin can be achieved while retaining uninvolved glans epithelium.
Total glans resurfacing
The epithelial surface across the glans is removed and the glans is reconstructed with a graft.
This can be particularly relevant when PeIN is extensive, multifocal, recurrent or difficult to define reliably as a small isolated area.
Resurfacing provides a larger tissue specimen
Topical treatment and laser treatment can be appropriate for selected superficial disease, but they do not provide the same complete surgical specimen.
Resurfacing allows the pathologist to examine the removed surface for:
- the final diagnosis
- extent of PeIN
- previously unsuspected invasive cancer
- tumour grade where invasion is identified
- margin status
What if deeper cancer is found after resurfacing?
A biopsy samples only part of an abnormal area.
Occasionally, the larger resurfacing specimen demonstrates a focus of invasive cancer that was not apparent from the original biopsy.
This does not necessarily mean that resurfacing was the wrong operation. One important advantage of the procedure is that it provides substantially more tissue for accurate local staging.
The next step then depends on:
- how deeply the tumour invades
- tumour grade
- margin status
- whether the invasive focus was completely removed
- risk of lymph-node involvement
Resurfacing, glansectomy or more extensive surgery?
These operations treat different depths of disease. The most tissue-preserving operation is not necessarily the safest operation for every tumour.
Glans Resurfacing
Preserves the deeper glans and removes the abnormal surface.
- extensive or recurrent PeIN
- selected superficial tumours
- skin-graft reconstruction
- full pathological assessment of the resected surface
Glansectomy
Removes part or all of the glans while preserving the shaft when oncologically appropriate.
- selected invasive cancers confined to the glans
- deeper tissue removal than resurfacing
- neoglans reconstruction may be performed
- shaft preservation may remain possible
Partial or Total Penectomy
More extensive surgery may be required when safe cancer clearance cannot be achieved with an organ-preserving procedure.
- deep or extensive local invasion
- corporal involvement
- large or recurrent tumours in selected circumstances
- cancer control remains the priority
Where does the skin graft come from?
A split-thickness skin graft is commonly used to reconstruct the glans after resurfacing.
A thin layer of skin can be harvested from another site, commonly the thigh.
The graft is then shaped and secured over the prepared glans surface.
The donor site heals separately and can initially resemble a superficial abrasion.
A dressing is therefore used to support the graft and reduce movement while blood supply develops between the graft and underlying tissue.
What happens to urination, erections and sensation?
One reason glans resurfacing is considered when oncologically appropriate is that the deeper structure of the penis is preserved.
Urination
The urethral opening is usually preserved. Temporary changes in urinary comfort or spraying can occur during healing.
Scar-related narrowing of the urinary opening is a possible longer-term complication.
Erections
The operation does not remove the erectile bodies of the shaft and is designed to preserve penile structure where oncologically appropriate.
Erectile function can still be influenced by age, vascular health, previous treatment and psychological effects of a cancer diagnosis.
Sensation & sexual function
Sensation and appearance can change after resurfacing. Temporary altered sensation is common during healing, and longer-term sensory experience varies between patients.
Organ preservation does not guarantee unchanged sexual function.
Does glans resurfacing treat the groin lymph nodes?
No.
Glans resurfacing treats the primary abnormality on the penis. Management of the groin lymph nodes is a separate part of penile cancer staging.
Pure PeIN does not have metastatic lymph-node spread because it is non-invasive. If invasive cancer is identified, however, tumour stage, grade and other pathological features help determine whether additional lymph-node assessment is needed.
Recovery after glans resurfacing
Early recovery is focused on protecting the graft, monitoring healing and then reviewing the final pathology.
Graft dressing
A supportive dressing is generally used over the graft during the early healing period.
Urinary catheter
A catheter may be used temporarily to keep urine away from the operative area and simplify early wound care.
Donor site
If a skin graft is harvested from the thigh, the donor site requires its own dressing while new skin forms.
Graft appearance
The graft can initially look swollen, irregular or different in colour. Appearance usually evolves substantially as healing progresses.
Sexual activity
Intercourse and masturbation are avoided during initial graft healing and resumed according to postoperative assessment.
Pathology review
Final pathology is reviewed after surgery because it confirms the diagnosis, depth of disease and whether further treatment or staging should be considered.
Risks and limitations of glans resurfacing
Surgical and graft-related risks
- pain and swelling
- bleeding
- infection
- partial graft loss
- complete graft failure
- delayed wound healing
- donor-site discomfort or scarring
- meatal narrowing or urinary spraying
Cancer and functional considerations
- unexpected invasive cancer on final pathology
- positive or close margins
- local recurrence
- need for further penile surgery
- need for lymph-node staging if invasive cancer is found
- altered glans appearance
- altered penile sensation
- change in sexual confidence or function
Follow-up is an important part of the treatment
Preserving penile tissue has important potential functional benefits, but it also means that the remaining penile surface needs ongoing surveillance.
Follow-up can include:
- inspection of the reconstructed glans
- assessment for recurrent PeIN or cancer
- review of the urethral opening and urinary stream
- examination of the groins where relevant
- review of sexual and reconstructive concerns
Current penile cancer guidelines specifically include the ability to comply with strict surveillance when considering penile-preserving surgery.
From abnormal glans lesion to follow-up
Specialist assessment
The penile abnormality, previous treatments, pathology and groin findings are reviewed.
Establish the pathology
Existing biopsy results are reviewed or tissue diagnosis arranged when necessary.
Determine whether penile preservation is appropriate
Disease location and depth are considered together with previous treatment and reconstructive options.
Glans resurfacing and reconstruction
The affected surface is removed and reconstructed with a graft when resurfacing is the appropriate operation.
Review final pathology
The complete surgical specimen determines whether treatment is complete or whether further local or lymph-node management should be considered.
Long-term surveillance
The glans, penis and groins are followed according to the final pathology and treatment received.
Dr Jack Crozier
Dr Jack Crozier is a Brisbane urologist with advanced fellowship experience in uro-oncology, andrology and reconstructive urology.
His practice includes penile cancer, penile-preserving surgery, complex genital reconstruction and assessment of urinary and sexual function following penile surgery.
Travelling to Brisbane for a penile cancer opinion?
Patients with an existing diagnosis of PeIN or penile cancer can provide available records before major travel arrangements are made where appropriate.
Particularly useful information can include:
- biopsy and pathology reports
- previous penile operation reports
- clinical photographs where available
- MRI, CT, PET or ultrasound reports and images
- oncology or urology correspondence
An in-person examination or additional investigations may still be required before a definitive treatment plan can be confirmed.
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Glans resurfacing FAQs
What is glans resurfacing?
Glans resurfacing is an organ-preserving operation in which abnormal surface tissue is removed from part or all of the glans while the deeper glans is preserved. The exposed area is then reconstructed, commonly with a skin graft.
What is PeIN?
PeIN stands for penile intraepithelial neoplasia. It is a precancerous abnormality in which atypical cells remain within the surface epithelium rather than invading deeply into penile tissue.
Does PeIN mean I already have invasive penile cancer?
No. PeIN is non-invasive disease. It is nevertheless important because it can persist, recur and progress to invasive penile cancer in a proportion of patients.
Is glans resurfacing only used for PeIN?
PeIN is one of the main indications, particularly when disease is extensive, recurrent or persistent. Resurfacing has also been used in carefully selected superficially invasive penile cancers when appropriate cancer clearance can still be achieved.
What is the difference between glans resurfacing and glansectomy?
Glans resurfacing removes the epithelial surface while preserving the deeper glans. Glansectomy removes part or all of the glans itself and is generally used when disease extends more deeply.
Is the whole glans removed during resurfacing?
No. The defining feature of resurfacing is preservation of the deeper glans tissue. Only the affected surface layer and appropriate superficial tissue are removed.
What is the difference between partial and total glans resurfacing?
Partial resurfacing treats a selected area of the glans. Total resurfacing removes and reconstructs the epithelial surface across the glans. The appropriate extent depends on how widely the abnormality is distributed.
Where does the skin graft come from?
A thin split-thickness skin graft is commonly harvested from the thigh or another suitable donor site and used to cover the prepared surface of the glans.
Can the skin graft fail?
Partial or complete graft loss is possible, although the glans generally provides a well-vascularised surface for graft healing. Infection, movement, bleeding beneath the graft and individual healing factors can affect graft take.
Why not just use cream or laser treatment?
Topical and ablative treatments can be appropriate for selected superficial disease. Resurfacing may be preferred in some patients because it physically removes the affected surface and provides a larger specimen for detailed pathological assessment.
Can invasive cancer be found after glans resurfacing?
Yes. Occasionally final examination of the larger surgical specimen identifies invasive disease that was not detected by the initial biopsy. The significance depends on the depth, grade, margins and other pathological findings.
What happens if invasive cancer is found?
Further treatment is not automatically required in every case. The final pathology is reviewed to determine whether the invasive focus was adequately removed and whether additional penile surgery, imaging or groin lymph-node staging should be considered.
Will glans resurfacing affect erections?
The deeper erectile structures of the penis are preserved during resurfacing. However, erectile function and sexual experience can still be influenced by healing, altered sensation, age, vascular health, previous treatment and the psychological effects of cancer treatment.
Will sensation be normal after resurfacing?
Sensation commonly changes during early healing. Longer-term sensation varies between patients and may not feel identical to the untreated glans.
Can I still pass urine normally?
The urethral opening is usually preserved. Most patients retain the normal distal urinary pathway, although temporary spraying, irritation and later narrowing of the urinary opening are possible.
Can PeIN or penile cancer come back after resurfacing?
Yes. Local recurrence can occur after any penile-preserving treatment. This is why regular inspection of the remaining penis forms an important part of long-term follow-up.
Does resurfacing mean I do not need lymph-node assessment?
Not necessarily. Pure PeIN does not spread to lymph nodes because it is non-invasive. If invasive penile cancer is present, however, the lymph-node pathway is determined separately according to tumour stage, grade and other pathological features.
Will I need circumcision?
Circumcision commonly forms part of management when the foreskin is present, particularly because penile intraepithelial neoplasia frequently involves the glans-preputial surfaces. The appropriate operation depends on the exact distribution of disease.
How long before I can have sex after resurfacing?
Sexual activity is avoided while the graft and surgical site heal. The exact timing depends on graft healing and postoperative review rather than a fixed date for every patient.
Can I be assessed if I live interstate or overseas?
Potentially. Pathology reports, previous operation reports, imaging and specialist correspondence can often be reviewed as part of preliminary planning. An in-person examination or further investigations may still be required before a definitive treatment recommendation is made.
Have you been diagnosed with PeIN or a superficial penile cancer?
Specialist assessment can help clarify the pathology, depth and extent of disease and whether glans resurfacing, another penile-preserving treatment, glansectomy or a different cancer pathway should be considered.
Medical information disclaimer: This page provides general educational information and does not replace individual medical advice, diagnosis or informed consent. A penile lesion cannot be reliably diagnosed from appearance or written information alone. Glans resurfacing is appropriate only for selected penile abnormalities and cancers. Treatment depends on clinical examination, biopsy and final pathology, tumour depth, grade, margins, previous treatment, lymph-node risk, general health and individual circumstances. Penile-preserving surgery may carry a risk of local recurrence and requires appropriate follow-up. Surgical outcomes, graft healing, penile appearance, sensation, urinary function, sexual function and avoidance of further cancer treatment cannot be guaranteed.