Objectives. To report the use of conservative extirpative surgical techniques to manage glanular carcinoma in situ with significant urethral extension. Methods. Over a 5-year period, 2 patients with carcinoma in situ of the glans with significant distal urethral involvement, who refused penectomy, were managed with combined treatment modalities using Mohs' micrographic surgery and distal urethrectomy with immediate urethral reconstruction. Results. At follow-up of 5 years and of 12 months, there has been no evidence of meatal or proximal urethral recurrence. Conclusions. Mohs' micrographic surgical excision and distal urethrectomy with immediate urethral reconstruction offers an acceptable alternative to partial penectomy in patients with perimeatal carcinoma in situ who fail conservative treatment or refuse penectomy.
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