Penile cancer

Overview

An uncommon squamous cell carcinoma of the penis, usually of the glans or prepuce, associated with HPV infection, phimosis and chronic inflammation, lichen sclerosus, smoking, and lack of circumcision. It presents as a non-healing penile lesion/ulcer; inguinal lymph node involvement is the key prognostic factor. Diagnosis is by biopsy at a specialist centre.

Recognise

• A non-healing ulcer, warty growth, plaque or area of induration on the glans/prepuce; bleeding, discharge, foul smell; phimosis may hide it
• Inguinal lymphadenopathy (key prognostic factor)
• Risk factors: HPV, phimosis/poor hygiene, lichen sclerosus, smoking, not circumcised; premalignant penile intraepithelial neoplasia

Differentials & how to tell them apart

Investigations

Biopsy of the lesion (definitive) at a specialist supra-network centre; examine/assess inguinal nodes (± imaging/biopsy); MRI for local staging; HPV status; exclude STI mimics.

Management

Specialist-centre biopsy → organ-preserving surgery (early) / penectomy (advanced); assess inguinal nodes

1. 1Biopsy any persistent penile lesion/ulcer at a specialist centre; assess the inguinal nodes and stage with MRI.Gate: Inguinal nodal involvement is the key prognostic factor — assess it and manage with lymphadenectomy as indicated; don't dismiss a persistent lesion as balanitis.
2. 2Organ-preserving treatment (topical/laser/glansectomy) for early disease; partial/total penectomy and chemo/radiotherapy for advanced/nodal disease; modify risk factors.

Monitor & prognosis

Surveillance for recurrence/nodal disease; risk-factor management.

Good if early and node-negative; nodal disease markedly worsens it.