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Case History

Image not available. A 65-year-old South American man presents with an ulcerated lesion on the glans penis; the only relevant clinical findings are phimosis and bilateral low-volume inguinal lymphadenopathy. A biopsy confirms squamous cell carcinoma.

Is this a typical presentation?

What is the next step in this patient's management?

Imaging confirms localized, possibly T1/2 disease.

What treatment options are available for this patient?

What is the importance of the inguinal lymphadenopathy? How does this influence the management options in this patient?

The patient had a penile-sparing procedure and re-presents 2 years later with a local recurrence.

What are the outlook and management options for this patient? Is there any role for chemotherapy?

Background

Is this a typical presentation?

Image not available. Penile cancer is a rare disease in developed countries. However, in certain parts of the developing world it can account for up to 10% of all male malignancies. Known predisposing factors include smoking and phimosis, which confer a threefold and 10-fold increased risk, respectively; neonatal circumcision appears to be protective. The commonest presentation is a solid lesion, however, ulcerated lesions are also common and occasionally inflammatory lesions are seen.

What is the next step in this patient's management?

Pathological and radiological staging should be the first priority. This should be established with a biopsy sufficient to assess the depth of invasion and to obtain adequate histological information. Furthermore, radiological imaging - computed tomography (CT)/magnetic resonance imaging (MRI) and urethroscopy - should be done to investigate any distant spread. The currently used staging system is the TNM classification, updated in 20021 (Tables 22.1 and 22.2).

Table 22.1TNM classification of penile cancers
Table 22.2Staging of penile cancers

Discussion

What treatment options are available for this patient?

Image not available. The gold standard for management of invasive penile cancer remains surgical excision. The extent will depend primarily on the depth of invasion. For T1 lesions the surgical excision margin should be sufficient to obtain at least 10 mm for grade 2 and 15 mm for grade 3 clear histological margin.2 Provided >2.5–3 cm penile length remains postoperatively, the possible ...

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