eMedicine Specialties > Urology > Cancer, Bladder, Penis, and Urethra

Penile Cancer: Workup

Author: Stanley A Brosman, MD, Clinical Professor, Department of Urology, University of California at Los Angeles Medical School
Contributor Information and Disclosures

Updated: Dec 3, 2008

Workup

Laboratory Studies

  • No specific laboratory studies or tumor markers are diagnostic for penile cancer.
  • A general evaluation, which includes a CBC count; a chemistry panel with liver function tests; and an assessment of cardiac, pulmonary, and renal status, is helpful as a baseline and in the detection of any unsuspected problems.
  • Patients with advanced penile cancer may be anemic, with leukocytosis and hypoalbuminemia.
  • Hypercalcemia has been found in some patients in the absence of metastases.

Imaging Studies

  • MRI and ultrasonography are useful for local cancer staging and for assessing the inguinal lymph nodes. These studies may be helpful for detecting tumor invasion into the corpora. MRI produces sharp images of the penile structures, is accurate for demonstrating invasion of the corpora, and can help the physician determine the extent of the cancer along the surface of the penis in patients with tumors larger than 2 cm.
  • Both MRI and CT scanning can demonstrate enlarged pelvic and retroperitoneal lymph nodes. Positron emission tomography (PET) and CT scanning have not been studied extensively but may be helpful and should be obtained in patients with high-grade and extensive local disease and in those with evidence of inguinal node involvement.
  • Rarely, chest radiography can help detect metastases. However, the preferred study to evaluate for metastases is CT scanning.
  • A technique to identify lymph node metastases using MRI following the intravenous injection of ferromagnetic particles has shown a high degree of sensitivity. Further study will be necessary to determine the tumor burden necessary for this imaging modality to be effective, but current results indicate that it is more accurate than conventional CT scanning.

Diagnostic Procedures

The most important diagnostic test is a biopsy. This may be an excisional biopsy if the cancer is small or the lesion is confined to the prepuce and a circumcision is acceptable. The biopsy should contain tissue beneath the tumor, if this is feasible, in order to help stage the disease.

CT-guided or ultrasound-guided fine-needle aspiration of enlarged lymph nodes may aid the urologist in planning therapy. Aspiration biopsies of sentinel nodes using the identification techniques described below have also been reported.

Sentinel node biopsy may be of assistance in determining the need for extensive inguinal lymphadenectomy. Various methods have been used to identify the sentinel node. One method involves intradermal injection of 2 mL of patent blue dye around the tumor. Approximately 15 minutes later, the node can be identified and removed for histologic assessment.

Lymphoscintigraphy is another method used to identify the sentinel node. This technique, developed at The Netherlands Cancer Center Institute, involves injecting technetium-99m nanocolloid around the primary tumor. Following the injection, dynamic images are taken with a gamma camera to visualize lymphatic drainage. Static scintigrams are obtained 2 hours after the injection. A hot spot in the inguinal area is considered to be a sentinel node, and its position is marked on the skin. In some instances, both techniques are used to identify the sentinel node. Kroon et al found that that the size of the metastasis was predictive of nonsentinel node metastasis. They reported that, in groins with only micrometastases in the sentinel node, none of the other nodes were involved.6

Tabatabaei and McDougal reported on their results using lymphotrophic nanoparticle-enhanced MRI and found that this technique yielded 100% sensitivity and 97% specificity.7

The major limitation of these techniques is the need to perform the test in all patients regardless of the presence of clinically normal nodes and histologic features of the primary tumor. Another possible concern is thrombosis of the lymphatic vessels cause by inflammation. Finally, inexperience with these techniques is an obstacle. It has been estimated that experience with 25 patients is needed to achieve the 4.8% false-negative rate reached by the Netherlands group, and few centers see enough patients to become proficient.

Histologic Findings

Most penile cancers are squamous cell carcinomas that demonstrate keratinization, epithelial pearl formation, and various degrees of mitotic activity. The normal rete pegs are disrupted, and invasive lesions penetrate the basement membrane and surrounding structures.

Erythroplasia of Queyrat, a red, velvety, well-marginated lesion usually occurring on the glans, is characterized by atypical hyperplastic cells that appear disoriented and vacuolated and have hyperchromatic nuclei and multiple mitotic figures. The submucosa shows capillary proliferation and ectasia with a surrounding inflammatory infiltrate rich in plasma cells.

Campos et al studied E-cadherin (cell adhesion molecules involved in the metastatic process), matrix metalloproteinase (MMP)–2, and MMP-9 (part of a group of enzymes that degrade collagen type IV in the basement membrane). In the 125 available tumor specimens and clinical records, they found that low levels of E-cadherin and high expression of MMP-9 represented independent risk factors for nodal disease.8

Guimaraes et al examined the value of proliferating cell nuclear antigen (PCNA) and MIB-1/Ki-67 to determine if these might serve as prognostic factors in predicting nodal metastasis. PCNA was an independent factor in univariate and multivariate analysis (RR, 2.94; 95% confidence interval, 1.1-7.7). Unexpectedly, a high expression of MIB-1/Ki-67 reactivity correlated with a decreased incidence of nodal metastases.9 Although these markers did have predictive value, they added little to the predictive value of tumor stage and grade and the presence of vascular invasion.

Staging

No universal staging system has been established for penile cancer. A detailed and accurate assessment of the primary tumor, including identification of regional and distant metastatic disease, is important for selecting appropriate therapy and for assessing and communicating results.

The Jackson and TNM systems are used, although the TNM system is preferable. In the Jackson system, characteristics of the primary lesion, such as size and confinement to the epidermis (superficial or invasive), are not used. The presence and extent of nodal metastases is not addressed. Histologic criteria are not used, even though the grade and extent of invasion is important.

Solsona et al presented the European Association of Urology (EAU) guidelines on penile cancer. They proposed 3 risk groups for patients with clinically negative or occult nodal metastases: low risk, stage T1, grade 1; intermediate, stage T1, grade 2 or 3; and high, T2-T3, grade 2-3.10 Most patients with positive sentinel node biopsy findings tend to fall into the high-risk category.

Most penile cancers are low grade, but correlation between grade and survival is lacking. High-grade disease is associated with regional lymph node metastases. The strongest predictor for survival is the presence or absence of nodal metastases.

The optimum surgical margin has been reduced from the classical 2 cm to 1 cm or, in some instances, to 0.5 cm, without any adverse consequences related to cancer recurrence or survival. The advantage of a smaller margin is important because nearly 80% of penile squamous cell carcinomas are distal, presenting on the prepuce, glans, or in the coronal sulcus. These lesions can be managed with local excision and reconstruction.

  • The Jackson classification is as follows:
    • Stage I (A): The tumor is confined to the glans, prepuce, or both.
    • Stage II (B): The tumor extends onto the shaft of the penis.
    • Stage III (C): The tumor has inguinal metastasis that is operable.
    • Stage IV (D): The tumor involves adjacent structures and is associated with inoperable inguinal metastasis or distant metastasis.
  • The TNM classification of the primary tumor (T) is below. Note that the following description is devoid of N (node) and M (metastasis) descriptions. These stages simply relate the presence or absence of nodal and distant metastases.
    • TX: Primary tumor cannot be assessed.
    • T0: Primary tumor is not evident.
    • Tis: CIS is present.
    • Ta: Noninvasive verrucous carcinoma is present.
    • T1: Tumor invades subepithelial connective tissue.
    • T2: Tumor invades corpora spongiosum or cavernosum.
    • T3: Tumor invades the urethra or prostate.
    • T4: Tumor invades other adjacent structures.
  • The WHO histopathological classification is as follows:
    • Grade 1 - Well differentiated, with 33% undifferentiated cells
    • Grade 2 - Moderately differentiated, with 33%-66% undifferentiated cells
    • Grade 3 - Poorly differentiated, with more than 66% undifferentiated cells

Novara and colleagues from the GUONE Penile Cancer Project compared the prognostic accuracy of the Solsona and European Association of Urology (EAU) risk groups in predicting lymph node metastases. They studied clinical and pathology data from 175 patients with squamous cell carcinoma from 1980-2002. Both groups used variations of the pathologic features and primary tumor stage. Although both risk groups could predict the probability of nodal metastases, their prognostic accuracy was poor when the data were analyzed according to the ROC curve analysis.11

More on Penile Cancer

Overview: Penile Cancer
Workup: Penile Cancer
Treatment: Penile Cancer
Follow-up: Penile Cancer
References
[ CLOSE WINDOW ]

References

  1. Barnholtz-Sloan JS, Maldonado JL, Pow-sang J, Giuliano AR. Incidence trends in primary malignant penile cancer. Urol Oncol. Sep-Oct 2007;25(5):361-7. [Medline].

  2. Seyam RM, Bissada NK, Mokhtar AA, et al. Outcome of penile cancer in circumcised men. J Urol. Feb 2006;175(2):557-61; discussion 561. [Medline].

  3. Madsen BS, van den Brule AJ, Jensen HL, Wohlfahrt J, Frisch M. Risk factors for squamous cell carcinoma of the penis--population-based case-control study in Denmark. Cancer Epidemiol Biomarkers Prev. Oct 2008;17(10):2683-91. [Medline].

  4. de Paula AA, Netto JC, Freitas R Jr, et al. Penile carcinoma: the role of koilocytosis in groin metastasis and the association with disease specific survival. J Urol. Apr 2007;177(4):1339-43; discussion 1343. [Medline].

  5. Rippentrop JM, Joslyn SA, Konety BR. Squamous cell carcinoma of the penis: evaluation of data from the surveillance, epidemiology, and end results program. Cancer. Sep 15 2004;101(6):1357-63. [Medline].

  6. Kroon BK, Horenblas S, Meinhardt W, et al. Dynamic sentinel node biopsy in penile carcinoma: evaluation of 10 years experience. Eur Urol. May 2005;47(5):601-6; discussion 606. [Medline].

  7. Tabatabaei S, McDougal WS. Invasive carcinoma of the penis: management and prognosis. In: Ritchie JP, D'Amico AV, eds. Urologic Oncology. Philadelphia: Elsevier/Saunders; 2005:710-22.

  8. Campos RS, Lopes A, Guimaraes GC, et al. E-cadherin, MMP-2, and MMP-9 as prognostic markers in penile cancer: analysis of 125 patients. Urology. Apr 2006;67(4):797-802. [Medline].

  9. Guimaraes GC, Leal ML, Campos RS, et al. Do proliferating cell nuclear antigen and MIB-1/Ki-67 have prognostic value in penile squamous cell carcinoma?. Urology. Jul 2007;70(1):137-42. [Medline].

  10. Solsona E, Algaba F, Horenblas S, et al. EAU Guidelines on Penile Cancer. Eur Urol. Jul 2004;46(1):1-8. [Medline].

  11. Novara G, Artibani W, Cunico SC, et al. How accurately do Solsona and European Association of Urology risk groups predict for risk of lymph node metastases in patients with squamous cell carcinoma of the penis?. Urology. Feb 2008;71(2):328-33. [Medline].

  12. Bermejo C, Busby JE, Spiess PE, et al. Neoadjuvant chemotherapy followed by aggressive surgical consolidation for metastatic penile squamous cell carcinoma. J Urol. Apr 2007;177(4):1335-8. [Medline].

  13. Shindel AW, Mann MW, Lev RY, et al. Mohs micrographic surgery for penile cancer: management and long-term followup. J Urol. Nov 2007;178(5):1980-5. [Medline].

  14. Brandes SB, Sengelmann R, Hruza G. Mohs micrographic surgery for penile cancer: management and long term follow-up [abstract 708]. J Urol. 2001;165:172.

  15. Gulino G, Sasso F, Falabella R, et al. Distal urethral reconstruction of the glans for penile carcinoma: results of a novel technique at 1-year of followup. J Urol. Sep 2007;178(3 Pt 1):941-4. [Medline].

  16. Ozsahin M, Jichlinski P, Weber DC, et al. Treatment of penile carcinoma: to cut or not to cut?. Int J Radiat Oncol Biol Phys. Nov 1 2006;66(3):674-9. [Medline].

  17. Kroon BK, Horenblas S, Lont AP, et al. Patients with penile carcinoma benefit from immediate resection of clinically occult lymph node metastases. J Urol. Mar 2005;173(3):816-9. [Medline].

  18. Bouchot O, Rigaud J, Maillet F, et al. Morbidity of inguinal lymphadenectomy for invasive penile carcinoma. Eur Urol. Jun 2004;45(6):761-5; discussion 765-6. [Medline].

  19. d'Ancona CA, de Lucena RG, Querne FA, et al. Long-term followup of penile carcinoma treated with penectomy and bilateral modified inguinal lymphadenectomy. J Urol. Aug 2004;172(2):498-501; discussion 501. [Medline].

  20. Horenblas S, Bex A, Tanis PJ. Sentinel node biopsy in squamous cell carcinoma of the penis [abstract 710]. J Urol. 2001;165:173.

  21. Izawa J, Tamboli P, Ainslie N. Intraoperative lymphatic mapping (IOLM) for squamous penile cancer: The M.D. Anderson experience [abstract 711]. J Urol. 2001;165:173.

  22. Horenblas S, Jansen L, Meinhardt W, et al. Detection of occult metastasis in squamous cell carcinoma of the penis using a dynamic sentinel node procedure. J Urol. Jan 2000;163(1):100-4. [Medline].

  23. Perdona S, Autorino R, De Sio M, et al. Dynamic sentinel node biopsy in clinically node-negative penile cancer versus radical inguinal lymphadenectomy: a comparative study. Urology. Dec 2005;66(6):1282-6. [Medline].

  24. Lont AP, Kroon BK, Gallee MP, et al. Pelvic lymph node dissection for penile carcinoma: extent of inguinal lymph node involvement as an indicator for pelvic lymph node involvement and survival. J Urol. Mar 2007;177(3):947-52; discussion 952. [Medline].

  25. Tobias-Machado M, Tavares A, Ornellas AA, et al. Video endoscopic inguinal lymphadenectomy: a new minimally invasive procedure for radical management of inguinal nodes in patients with penile squamous cell carcinoma. J Urol. Mar 2007;177(3):953-7; discussion 958. [Medline].

  26. Novak JA, Dvoaeek J. Interstitial brachytherapy for penile carcinoma [abstract 709]. J Urol. 2001;165:173.

  27. Hegarty PK, Kayes O, Freeman A, et al. A prospective study of 100 cases of penile cancer managed according to European Association of Urology guidelines. BJU Int. Sep 2006;98(3):526-31. [Medline].

  28. Slaton JW, Huang SF, Levy DA. Lymph node-positive squamous penile carcinoma: Extent of nodal involvement predicts 3-year disease-free survival [abstract 712]. J Urol. 2001;165:173.

  29. Agrawal A, Pai D, Ananthakrishnan N, et al. The histological extent of the local spread of carcinoma of the penis and its therapeutic implications. BJU Int. Feb 2000;85(3):299-301. [Medline].

  30. Algaba F, Horenblas S, Pizzocaro-Luigi Piva G, et al. EAU guidelines on penile cancer. Eur Urol. Sep 2002;42(3):199-203. [Medline].

  31. Bevan-Thomas R, Slaton JW, Pettaway CA. Contemporary morbidity from lymphadenectomy for penile squamous cell carcinoma: the M.D. Anderson Cancer Center Experience. J Urol. Apr 2002;167(4):1638-42. [Medline].

  32. Bissada NK. Conservative extirpative treatment of cancer of the penis. Urol Clin North Am. May 1992;19(2):283-90. [Medline].

  33. Bissada NK, Yakout HH, Fahmy WE, et al. Multi-institutional long-term experience with conservative surgery for invasive penile carcinoma. J Urol. Feb 2003;169(2):500-2. [Medline].

  34. Brennhovd B, Johnsrud K, Berner A, et al. Sentinel node procedure in low-stage/low-grade penile carcinomas. Scand J Urol Nephrol. 2006;40(3):204-7. [Medline].

  35. Brown CT, Minhas S, Ralph DJ. Conservative surgery for penile cancer: subtotal glans excision without grafting. BJU Int. Oct 2005;96(6):911-2. [Medline].

  36. Burgers JK, Badalament RA, Drago JR. Penile cancer. Clinical presentation, diagnosis, and staging. Urol Clin North Am. May 1992;19(2):247-56. [Medline].

  37. Busby JE, Pettaway CA. What's new in the management of penile cancer?. Curr Opin Urol. Sep 2005;15(5):350-7. [Medline].

  38. Catalona WJ. Modified inguinal lymphadenectomy for carcinoma of the penis with preservation of saphenous veins: technique and preliminary results. J Urol. Aug 1988;140(2):306-10. [Medline].

  39. Coblentz TR, Theodorescu D. Morbidity of modified prophylactic inguinal lymphadenectomy for squamous cell carcinoma of the penis. J Urol. Oct 2002;168(4 Pt 1):1386-9. [Medline].

  40. Colberg JW, Andriole GL, Catalona WJ. Long-term follow-up of men undergoing modified inguinal lymphadenectomy for carcinoma of the penis. Br J Urol. Jan 1997;79(1):54-7. [Medline].

  41. Cubilla AL, Ayala AG, Dillner J, et al. Tumours of the penis. In: Eble JN, Sauter G, Epstein JI, Sesterhenn IA, eds. Pathology and Genetics of Tumors of the Urinary System and Male Genital Organs. Lyon, France: IARC Press; 2004.

  42. Culkin DJ, Beer TM. Advanced penile carcinoma. J Urol. Aug 2003;170(2 Pt 1):359-65. [Medline].

  43. Dai B, Ye DW, Kong YY, et al. Predicting regional lymph node metastasis in Chinese patients with penile squamous cell carcinoma: the role of histopathological classification, tumor stage and depth of invasion. J Urol. Oct 2006;176(4 Pt 1):1431-5; discussion 1435. [Medline].

  44. Das S. Penile amputations for the management of primary carcinoma of the penis. Urol Clin North Am. May 1992;19(2):277-82. [Medline].

  45. Davis JW, Schellhammer PF, Schlossberg SM. Conservative surgical therapy for penile and urethral carcinoma. Urology. Feb 1999;53(2):386-92. [Medline].

  46. Dewire D, Lepor H. Anatomic considerations of the penis and its lymphatic drainage. Urol Clin North Am. May 1992;19(2):211-9. [Medline].

  47. Dillner J, von Krogh G, Horenblas S, et al. Etiology of squamous cell carcinoma of the penis. Scand J Urol Nephrol Suppl. 2000;189-93. [Medline].

  48. Donat SM. Surgery of penile and urethral carcinoma. In: Campbell's Urology. 8th ed. 2002:2985-3004.

  49. Eisenberger MA. Chemotherapy for carcinomas of the penis and urethra. Urol Clin North Am. May 1992;19(2):333-8. [Medline].

  50. Emerson RE, Ulbright TM, Eble JN, et al. Predicting cancer progression in patients with penile squamous cell carcinoma: the importance of depth of invasion and vascular invasion. Mod Pathol. Oct 2001;14(10):963-8. [Medline].

  51. Ficarra V, Zattoni F, Artibani W, et al. Nomogram predictive of pathological inguinal lymph node involvement in patients with squamous cell carcinoma of the penis. J Urol. May 2006;175(5):1700-4; discussion 1704-5. [Medline].

  52. Ficarra V, Zattoni F, Cunico SC, et al. Lymphatic and vascular embolizations are independent predictive variables of inguinal lymph node involvement in patients with squamous cell carcinoma of the penis: Gruppo Uro-Oncologico del Nord Est (Northeast Uro-Oncological Group) Penile Cancer data base data. Cancer. Jun 15 2005;103(12):2507-16. [Medline].

  53. Fossa SD, Hall KS, Johannessen NB, et al. Cancer of the penis. Experience at the Norwegian Radium Hospital 1974-1985. Eur Urol. 1987;13(6):372-7. [Medline].

  54. Fraley EE, Zhang G, Manivel C, et al. The role of ilioinguinal lymphadenectomy and significance of histological differentiation in treatment of carcinoma of the penis. J Urol. Dec 1989;142(6):1478-82. [Medline].

  55. Gerbaulet A, Lambin P. Radiation therapy of cancer of the penis. Indications, advantages, and pitfalls. Urol Clin North Am. May 1992;19(2):325-32. [Medline].

  56. Grossman HB. Premalignant and early carcinomas of the penis and scrotum. Urol Clin North Am. May 1992;19(2):221-6. [Medline].

  57. Hakenberg OW, Nippgen JB, Froehner M, et al. Cisplatin, methotrexate and bleomycin for treating advanced penile carcinoma. BJU Int. Dec 2006;98(6):1225-7. [Medline].

  58. Hatzichristou DG, Apostolidis A, Tzortzis V, et al. Glansectomy: an alternative surgical treatment for Buschke-Löwenstein tumors of the penis. Urology. May 2001;57(5):966-9. [Medline].

  59. Hoffman MA, Renshaw AA, Loughlin KR. Squamous cell carcinoma of the penis and microscopic pathologic margins: how much margin is needed for local cure?. Cancer. Apr 1 1999;85(7):1565-8. [Medline].

  60. Horenblas S. Lymphadenectomy for squamous cell carcinoma of the penis. Part 1: diagnosis of lymph node metastasis. BJU Int. Sep 2001;88(5):467-72. [Medline].

  61. Horenblas S. Lymphadenectomy for squamous cell carcinoma of the penis. Part 2: the role and technique of lymph node dissection. BJU Int. Sep 2001;88(5):473-83. [Medline].

  62. Horenblas S, van Tinteren H. Squamous cell carcinoma of the penis. IV. Prognostic factors of survival: analysis of tumor, nodes and metastasis classification system. J Urol. May 1994;151(5):1239-43. [Medline].

  63. Horenblas S, van Tinteren H, Delemarre JF, et al. Squamous cell carcinoma of the penis. II. Treatment of the primary tumor. J Urol. Jun 1992;147(6):1533-8. [Medline].

  64. Horenblas S, van Tinteren H, Delemarre JF, et al. Squamous cell carcinoma of the penis. III. Treatment of regional lymph nodes. J Urol. Mar 1993;149(3):492-7. [Medline].

  65. Krieg R, Hoffman R. Current management of unusual genitourinary cancers. Part 1: Penile cancer. Oncology (Williston Park). Oct 1999;13(10):1347-52. [Medline].

  66. Kroon BK, Horenblas S, Deurloo EE, et al. Ultrasonography-guided fine-needle aspiration cytology before sentinel node biopsy in patients with penile carcinoma. BJU Int. Mar 2005;95(4):517-21. [Medline].

  67. Kroon BK, Horenblas S, Estourgie SH, et al. How to avoid false-negative dynamic sentinel node procedures in penile carcinoma. J Urol. Jun 2004;171(6 Pt 1):2191-4. [Medline].

  68. Kroon BK, Lont AP, Valdes Olmos RA, et al. Morbidity of dynamic sentinel node biopsy in penile carcinoma. J Urol. Mar 2005;173(3):813-5. [Medline].

  69. Kulkarni JN, Kamat MR. Prophylactic bilateral groin node dissection versus prophylactic radiotherapy and surveillance in patients with N0 and N1-2A carcinoma of the penis. Eur Urol. 1994;26(2):123-8. [Medline].

  70. Leijte JA, Kroon BK, Valdes Olmos RA, et al. Reliability and safety of current dynamic sentinel node biopsy for penile carcinoma. Eur Urol. Jul 2007;52(1):170-7. [Medline].

  71. Lont AP, Horenblas S, Tanis PJ, et al. Management of clinically node negative penile carcinoma: improved survival after the introduction of dynamic sentinel node biopsy. J Urol. Sep 2003;170(3):783-6. [Medline].

  72. Lubke WL, Thompson IM. The case for inguinal lymph node dissection in the treatment of T2-T4, N0 penile cancer. Semin Urol. May 1993;11(2):80-4. [Medline].

  73. Lynch DF Jr, Pettaway CA. Tumors of the Penis. In: Campbell MR, Walsh PC, Retik AB, eds. Campbell's Urology. 8th ed. Philadelphia, Pa: WB Saunders; 2002:2945-82.

  74. McCance DJ, Kopan R, Fuchs E, et al. Human papillomavirus type 16 alters human epithelial cell differentiation in vitro. Proc Natl Acad Sci U S A. Oct 1988;85(19):7169-73. [Medline].

  75. McDougal WS. Carcinoma of the penis: improved survival by early regional lymphadenectomy based on the histological grade and depth of invasion of the primary lesion. J Urol. Oct 1995;154(4):1364-6. [Medline].

  76. McDougal WS. Phallic preserving surgery in patients with invasive squamous cell carcinoma of the penis. J Urol. Dec 2005;174(6):2218-20, discussion 2220. [Medline].

  77. McLean M, Akl AM, Warde P, et al. The results of primary radiation therapy in the management of squamous cell carcinoma of the penis. Int J Radiat Oncol Biol Phys. Mar 15 1993;25(4):623-8. [Medline].

  78. Micali G, Nasca MR, Tedeschi A. Topical treatment of intraepithelial penile carcinoma with imiquimod. Clin Exp Dermatol. Nov 2003;28 Suppl 1:4-6. [Medline].

  79. Misra S, Chaturvedi A, Misra NC. Penile carcinoma: a challenge for the developing world. Lancet Oncol. Apr 2004;5(4):240-7. [Medline].

  80. Mobilio G, Ficarra V. Genital treatment of penile carcinoma. Curr Opin Urol. May 2001;11(3):299-304. [Medline].

  81. Mohs FE, Snow SN, Larson PO. Mohs micrographic surgery for penile tumors. Urol Clin North Am. May 1992;19(2):291-304. [Medline].

  82. Mukamel E, deKernion JB. Early versus delayed lymph-node dissection versus no lymph-node dissection in carcinoma of the penis. Urol Clin North Am. Nov 1987;14(4):707-11. [Medline].

  83. Nelson BA, Cookson MS, Smith JA Jr, et al. Complications of inguinal and pelvic lymphadenectomy for squamous cell carcinoma of the penis: a contemporary series. J Urol. Aug 2004;172(2):494-7. [Medline].

  84. Novara G, Galfano A, De Marco V, Artibani W, Ficarra V. Prognostic factors in squamous cell carcinoma of the penis. Nat Clin Pract Urol. Mar 2007;4(3):140-6. [Medline].

  85. Opjordsmoen S, Fosså SD. Quality of life in patients treated for penile cancer. A follow-up study. Br J Urol. Nov 1994;74(5):652-7. [Medline].

  86. Ornellas AA, Seixas AL, Marota A, et al. Surgical treatment of invasive squamous cell carcinoma of the penis: retrospective analysis of 350 cases. J Urol. May 1994;151(5):1244-9. [Medline].

  87. Pietrzak P, Corbishley C, Watkin N. Organ-sparing surgery for invasive penile cancer: early follow-up data. BJU Int. Dec 2004;94(9):1253-7. [Medline].

  88. Poblet E, Alfaro L, Fernander-Segoviano P, et al. Human papillomavirus-associated penile squamous cell carcinoma in HIV-positive patients. Am J Surg Pathol. Sep 1999;23(9):1119-23. [Medline].

  89. Pugliese JM, Morey AF, Peterson AC. Lichen sclerosus: review of the literature and current recommendations for management. J Urol. Dec 2007;178(6):2268-76. [Medline].

  90. Sarin R, Norman AR, Steel GG, et al. Treatment results and prognostic factors in 101 men treated for squamous carcinoma of the penis. Int J Radiat Oncol Biol Phys. Jul 1 1997;38(4):713-22. [Medline].

  91. Seixas AL, Ornellas AA, Marota A, et al. Verrucous carcinoma of the penis: retrospective analysis of 32 cases. J Urol. Nov 1994;152(5 Pt 1):1476-8; discussion 1478-9. [Medline].

  92. Seyam RM, Bissada NK, Mokhtar AA, Mourad WA, Aslam M, Elkum N, et al. Outcome of penile cancer in circumcised men. J Urol. Feb 2006;175(2):557-61; discussion 561. [Medline].

  93. Shindel AW, Mann MW, Lev RY, Sengelmann R, Petersen J, Hruza GJ, et al. Mohs micrographic surgery for penile cancer: management and long-term followup. J Urol. Nov 2007;178(5):1980-5. [Medline].

  94. Slaton JW, Morgenstern N, Levy DA, et al. Tumor stage, vascular invasion and the percentage of poorly differentiated cancer: independent prognosticators for inguinal lymph node metastasis in penile squamous cancer. J Urol. Apr 2001;165(4):1138-42. [Medline].

  95. Solsona E, Iborra I, Rubio J, et al. Prospective validation of the association of local tumor stage and grade as a predictive factor for occult lymph node micrometastasis in patients with penile carcinoma and clinically negative inguinal lymph nodes. J Urol. May 2001;165(5):1506-9. [Medline].

  96. Srinivas V, Morse MJ, Herr HW, et al. Penile cancer: relation of extent of nodal metastasis to survival. J Urol. May 1987;137(5):880-2. [Medline].

  97. Tabatabaei S, Harisinghani M, McDougal WS. Regional lymph node staging using lymphotropic nanoparticle enhanced magnetic resonance imaging with ferumoxtran-10 in patients with penile cancer. J Urol. Sep 2005;174(3):923-7; discussion 927. [Medline].

  98. Tanis PJ, Lont AP, Meinhardt W, et al. Dynamic sentinel node biopsy for penile cancer: reliability of a staging technique. J Urol. Jul 2002;168(1):76-80. [Medline].

  99. Taussky D, Crook J, Al Ghamdi A, et al. Treatment of the inguinal regions in penile cancer: a review of the literature and treatment proposal. Can J Urol. Feb 2006;13(1):2978-83. [Medline].

  100. Theodorescu D, Russo P, Zhang ZF, et al. Outcomes of initial surveillance of invasive squamous cell carcinoma of the penis and negative nodes. J Urol. May 1996;155(5):1626-31. [Medline].

  101. Tietjen DN, Malek RS. Laser therapy of squamous cell dysplasia and carcinoma of the penis. Urology. Oct 1998;52(4):559-65. [Medline].

  102. von Krogh G, Horenblas S. The management and prevention of premalignant penile lesions. Scand J Urol Nephrol Suppl. 2000;220-9. [Medline].

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Further Reading

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Keywords

penile cancer, penile carcinoma, penis cancer, penile malignancies, cancer of the penis, carcinoma of the penis, squamous cell carcinomas, SCCs, penile tumor, penis tumor, warty growth, exophytic growth, smegma, human papilloma virus, human papillomavirus, penile autoamputation, pearly penile papules, hirsute papillomas, coronal papillae, balanitis xerotica obliterans, leukoplakia, condyloma acuminata, venereal warts, Kaposi sarcoma, Buschke-Lowenstein tumor, penile carcinoma in situ, penile CIS, erythroplasia of Queyrat, Bowen disease, complete penectomy, partial penectomy, radical penectomy

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Contributor Information and Disclosures

Author

Stanley A Brosman, MD, Clinical Professor, Department of Urology, University of California at Los Angeles Medical School
Stanley A Brosman, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association for Cancer Research, American Association for the Advancement of Science, American College of Surgeons, American Medical Association, American Society of Clinical Oncology, American Urological Association, Association of Clinical Research Professionals, International Society of Urological Pathology, Société Internationale d'Urologie (International Society of Urology), Society for Basic Urologic Research, Society of Surgical Oncology, Society of Urologic Oncology, and Western Section American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Gamal Mostafa Ghoniem, MD, FACS, Fellowship Program Director, Clinical Professor of Surgery, Head, Section of Voiding Dysfunction, Female Urology and Reconstruction, Cleveland Clinic Florida
Gamal Mostafa Ghoniem, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Society for Urology and Engineering, and Society of University Urologists
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Dan Theodorescu, MD, PhD, Paul Mellon Professor of Urologic Oncology, Department of Urology, University of Virginia Health Sciences Center
Dan Theodorescu, MD, PhD is a member of the following medical societies: American Cancer Society, American College of Surgeons, American Urological Association, Medical Society of Virginia, Society for Basic Urologic Research, and Society of Urologic Oncology
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Bradley Fields Schwartz, DO, FACS, Associate Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine
Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Nothing to disclose.

 
 
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