Penile Cancer

Rare (~1 in 100,000). 95% are squamous cell carcinomas, associated with HPV types 16, 18, and 31. Main risk factors: smoking, poor hygiene, multiple sexual partners.

Examination

Usually starts as a nodular, warty growth on the glans or coronal sulcus. There may be a foul-smelling, blood-stained discharge from under the foreskin. Inguinal lymphadenopathy is palpable in 28–64% at presentation, with almost 50% of these representing regionally advanced disease — always examine the groins.

Any balanitis or other glans/foreskin lesion that is persistent, non-healing, indurated, or ulcerated, and not responding to standard treatment, should raise suspicion and prompt referral (see Balanitis).

Management

Refer to urology/oncology for multidisciplinary management. Localised disease is increasingly managed with organ-preserving approaches (glans resurfacing, partial penectomy) where feasible, reflecting an international shift (EAU/ASCO guidance) toward preserving function and quality of life without compromising oncological outcome; more extensive disease may still need more radical surgery. Radiotherapy/chemoradiotherapy is used for select cases or those unfit for/declining surgery. Inguinal lymph node assessment and management (increasingly with sentinel node techniques to reduce the morbidity of routine full dissection) is a key part of staging given how often nodal disease is present at diagnosis.