Management of penile tumours during the Byzantine period

By Marios Papadakis, Eelco de Bree, Constantinos Trompoukis and Andreas Manios

JBUON, Vol.20:2 (2015)

Abstract: While conventional treatment of penile cancer consists of total penile amputation and bilateral lymphadenectomy, recently a more conservative strategy comprising penile-preserving surgery and selective lymphadenectomy has been applied in order to preserve the penis and to minimize unnecessary inguinal lymphadenectomy. A thorough literature survey was performed to see what was already known of the surgical treatment of penile tumours in ancient times. In the Byzantine period, surgery appeared to have been highly developed, as one may conclude from the surgical material included mainly in the works of Oribasius of Pergamus and Paul of Aegina. Being aware of cancer, they described in their medical encyclopaedias malignant and benign tumours of the prepuce and glans penis, as well as their surgical and non-surgical management. After local excision of malignant tumours, they strongly recommended burning to prevent relapse, whereas they discouraged simultaneous removal of external and internal preputial lesions, because of the risk of perforation of the prepuce. These surprisingly detailed descriptions prove that Byzantine surgery had reached a higher level than commonly supposed. Penile-preserving treatment, which has recently become the therapeutic strategy of choice, was already accomplished in ancient times by using adjuvant thermal or chemical burning after local tumour excision.

Excerpt: Both Oribasius of Pergamus and Paul of Aegina used the word “thyme” (pl. thymi) to describe penile tumours. The word thyme (or thymion) is derived from the Greek noun θύμος, a product of the verb θύω which means ‘to spring up’. The word is used to describe a genus of aromatic perennial herbaceous plants growing flat in the ground (like penile tumours). Celsus used the word thymion (pl. thymions) to depict thymi on genitals, centuries before Oribasius and Paul. He described the lesion as “an elevated tumour above the surface of the body like a small wart, narrow at the skin, broader above, and somewhat hard, with a very rough surface, of the colour of the herb thyme; and being easily divided, it discharges a cruentate matter, and sometimes pure blood”. He marked that thymions appear “on the palms or lower parts of the feet, though the worst occur about the genitals, and have more disposition to bleed there”.


Celsus considered that simple excision is more than enough for their radical removal and he quoted that they can also be removed by applying on them “a fig boiled in water”. Oribasius and Paul discriminated penile thymi in malignant and benign. The term “malignant thymi” obviously referred to the penile cancer. They both recommended the surgical excision of these lesions and emphasized the value of supplementary thermal (cauterization) or chemical burning (application of caustics). Otherwise, relapse seemed more than possible. The management of such lesions was a reality of every day surgical practice, as Francis Adams (Paul’s translator) commented that malignant penile tumours were quite frequent: “… these intractable tumors on the genital member are now frequently met with…”. Paul was aware of the possibility of lymph node affection in patients with such tumours. He considered the painful lymph nodes cancerous for which surgery had little to offer.

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