The clinical presentation of an invasive penile carcinoma is varied and may range from an area of induration or erythema to a nonhealing ulcer or a warty exophytic growth. Phimosis may obscure the tumor, thus possibly delaying diagnosis of the tumor until a bloody or foul-smelling discharge occurs.
All penile lesions, particularly those under a nonretractile foreskin, require a high index of suspicion for neoplasia. A penile lesion that does not resolve after 2 to 3 weeks of careful observation and skin care requires biopsy. If possible, biopsies should include enough tissue to determine the depth of invasion since this will ultimately affect therapy. In large lesions, the diagnosis is obtained by incisional biopsy.
In decreasing order of frequency, penile cancer develops in the glans (48%), prepuce (21%), glans and prepuce (9%), coronal sulcus (6%), and shaft (<2%). Careful palpation of the inguinal regions is important since palpable inguinal lymphadenopathy is present at diagnosis in 58% of patients (range 20% to 96%), and metastatic carcinoma will ultimately be diagnosed in 45% of these patients. The remainder will have inflammatory lymphadenopathy that resolves following resection of the primary tumor and a 4- to 6-week course of oral antibiotics. In patients with nonpalpable inguinal lymph nodes at the time of resection of the primary tumor, 20% will ultimately be found to have metastatic disease in the superficial groin nodes. Late in the course of the disease, metastasis to retroperitoneal nodes, liver, lung, and brain can occur. Bulky unresectable nodes can erode into the femoral vessels leading to exsanguinating hemorrhage.
The physical examination is key to the clinical evaluation of the patient with penile cancer. The assessment of the primary tumor should include the size, location, fixation, and involvement of the corporal bodies. The penile base and scrotum should be inspected to exclude neoplastic extension. Both groins should be palpated for inguinal lymphadenopathy.
Cancer Control. 2002;9(4) © 2002 H. Lee Moffitt Cancer Center and Research Institute, Inc.
© Copyright by H. Lee Moffitt Cancer Center & Research Institute. All rights reserved.
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Cite this: Cancer of the Penis - Medscape - Jul 01, 2002.