Penile squamous cell carcinoma

Synonyms

Squamous cell carcinoma of the penis,

Overview

A rare urogenital tumor characterized by origin from squamous epithelial cells of the penis, most commonly the glans or inner surface of the prepuce. Macroscopically, the tumors can appear either papillary or flat and ulcerating. Histological subtypes include usual squamous cell carcinoma as the most common type, as well as basaloid, warty, verrucous, papillary, and mixed carcinomas. Patients may initially be asymptomatic but present with itching, bleeding, discharge, foul odor, and pain, as the disease progresses. Regional lymph node involvement is common, while distant metastases occur only late in the disease. Risk factors include HPV infection, smoking, poor hygiene, and HIV infection. Neonatal circumcision is implicated as strongly protective.

Primary penile SCC may occur at any anatomic site on the penis. It most often occurs on the glans, although it may also develop on the prepuce, both the glans and the prepuce, the coronal sulcus, and the shaft. Invasion of the shaft by a tumor originating from more distant sites may also be observed.

Diagnosis

Patients note changes of the glans or foreskin, but experience no pain. In many cases, the diagnosis of exophytic penile cancer is established by inspection. Superficial stages of penile cancer are often limited to surface changes. Early suspicion and biopsy are necessary to prevent delays in treatment initiation.

Treatment

The treatment of penile SCC varies according to the clinical stage. Treatment includes radiation therapy, medical therapy (local and systemic), and surgery, alone or in combination. Laser therapy is also used. Because of the generally limited experience with SCC of the penis, considerable controversy exists as to the best form of treatment, specifically treatment for regional lymph nodes.