Penile cancer and penile sparing surgery – current concepts

Authors: A. Eldefrawy ;  D. J. Culkin
Published in: Urol List 2016; 14(1): 19-23


Penile cancer is a rare urological malignancy with multifactorial etiology. The vast majority of penile cancer has squamous cell carcinoma histology but there can be multiple variants. Diagnostic imaging modalities as well as surgical approaches have evolved over time and have limited morbidity of treatment. Penile sparing surgery is a well established more appealing approach for men with penile cancer. Our aim is to provide a comprehensive updated review about penile cancer natural history, diagnosis, and penile sparing approaches.

Key words:
penile cancer, prognosis, penile sparing surgery


1. Forman D, de Martel C, Lacey CJ et al. Global burden of human papillomavirus and related diseases. Vaccine 2012; 30 (Suppl 5): F12–F23. doi: 10.1016/j.vaccine.2012.07.055.

2. Guimar~aes GC, Cunha IW, Soares FA et al. Penile squamous cell carcinoma clinicopathological features, nodal metastasis and outcome in 333 cases. J Urol 2009; 182 (2): 528–534. doi: 10.1016/j.juro.2009.04.028.

3. 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 2006; 98(3): 526–531.

4. Arya M, Kalsi J, Kelly J et al. Malignant and premalignant lesions of the penis. BMJ 2013; 346: f1149. doi: 10.1136/bmj.f1149.

5. Chaux A, Lezcano C, Cubilla AL et al. Comparison of subtypes of penile squamous cell carcinoma from high and low incidence geographical re­gions. Int J Surg Pathol 2010; 18(4): 268–277. doi: 10.1177/1066896909339184.

6. Hernandez BY, Barnholtz-Sloan J, German RR et al. Burden of invasive squamous cell carcinoma of the penis in the United States, 1998–2003. Cancer 2008; 113 (Suppl 10): 2883–2891. doi: 10.1002/cncr.23743.

7. Barnholtz-Sloan JS, Maldonado JL, Pow-sang J et al. Incidence trends in primary malignant penile cancer. Urol Oncol 2007; 25(5): 361–367.

8. Bleeker MC, Heideman DA, Snijders PJ et al. Penile cancer: epidemiology, pathogenesis and prevention. World J Urol 2009; 27(2): 141–150. doi: 10.1007/s00345-008-0302-z.

9. Dillner J, von Krogh G, Horenblas S et al. Etiology of squamous cell carcinoma of the penis. Scand J Urol Nephrol Suppl 2000; 205: 189–193.

10. Grulich AE, Jin F, Conway EL et al. Cancers attrib­utable to human papillomavirus infection. Sex Health 2010; 7(3): 244–252. doi: 10.1071/SH10020.

11. Maden C, Sherman KJ, Beckmann AM et al. History of circumcision, medical conditions, and sexual activity and risk of penile cancer. J Natl Cancer Inst 1993; 85(1): 19–24.

12. Daling JR, Madeleine MM, Johnson LG et al. Penile cancer: importance of circumcision, human papillomavirus and smoking in in situ and invasive disease. Int J Cancer 2005; 116(4): 606–616.

13. Velazquez EF, Cubilla AL. Lichen sclerosus in 68 patients with squamous cell carcinoma of the penis: frequent atypias and correlation with special carcinoma variants suggests a precancerous role. Am J Surg Pathol 2003; 27(11): 1448–1453.

14. Nasca MR, Innocenzi D, Micali G. Association of penile lichen sclerosus and oncogenic human papillomavirus infection. Int J Dermatol 2006; 45(6): ­681–683.

15. Powell J, Robson A, Cranston D et al. High incidence of lichen sclerosus in patients with squamous cell carcinoma of the penis. Br J Dermatol 2001; 145(1): 85–89.

16. Archier E, Devaux S, Castela E et al. Carcinogenic risks of psoralen UV-A therapy and narrowband UV-B therapy in chronic plaque psoriasis: a systematic literature review. J Eur Acad Dermatol Venereol 2012; 26 (Suppl 3): 22–31. doi: 10.1111/j.1468-3083.2012.04520.x.

17. Stern RS, Bagheri S, Nichols K. The persistent risk of genital tumors among men treated with psoralen plus ultraviolet A (PUVA) for psoriasis. J Am Acad Dermatol 2002; 47(1): 33–39.

18. Perkins W, Lamont D, MacKie RM. Cutaneous malignancy in males treated with photochemotherapy. Lancet 1990; 336(8725): 1248.

19. Pow-Sang MR, Ferreira U, Pow-Sang JM et al. Epidemiology and natural history of penile cancer. Urology 2010; 76 (2 Suppl 1): S2–S6. doi: 10.1016/j.urology.2010.03.003.

20. Narayana AS, Olney LE, Loening SA et al. Carcinoma of the penis: analysis of 219 cases. Cancer 1982; 49(10): 2185–2191.

21. Skeppner E, Andersson SO, Johansson JE et al. Initial symptoms and delay in patients with penile carcinoma. Scand J Urol Nephrol 2012; 46(5): 319–325. doi: 10.3109/00365599.2012.677473.

22. Cubilla AL, Lloveras B, Alejo M et al. The basaloid cell is the best tissue marker for human papillomavirus in invasive penile squamous cell carcinoma: a study of 202 cases from Paraguay. Am J Surg Pathol 2010; 34(1): 104–114. doi: 10.1097/PAS.0b013e3181c76a49.

23. Cubilla AL, Reuter V, Velazquez E et al. Histologic classification of penile carcinoma and its relation to outcome in 61 patients with primary resection. Int J Surg Pathol 2001; 9(2): 111–120.

24. Lughezzani G, Catanzaro M, Torelli T et al. The relationship between characteristics of inguinal lymph nodes and pelvic lymph node involvement in penile squamous cell carcinoma: a single institution expe­rience. J Urol 2014; 191(4): 977–982. doi: 10.1016/j.juro.2013.10.140.

25. Syed S, Eng TY, Thomas CR et al. Current issues in the management of advanced squamous cell carcinoma of the penis. Urol Oncol 2003; 21(6): 431–438.

26. Cubilla AL. The role of pathologic prognostic factors in squamous cell carcinoma of the penis. World J Urol 2009; 27(2): 169–77. doi: 10.1007/s00345-008-0315-7.

27. Cubilla AL, Reuter VE, Gregoire L et al. Basaloid squamous cell carcinoma: a distinctive human papilloma virus-related penile neoplasm: a report of 20 cases. Am J Surg Pathol 1998; 22(6): 755–761.

28. Cubilla AL, Velazques EF, Reuter VE et al. Warty (condylomatous) squamous cell carcinoma of the penis: a report of 11 cases and proposed classifica­tion of ‚verruciform‘ penile tumors. Am J Surg Pathol 2000; 24(4): 505–512.

29. Chaux A, Soares F, Rodríguez I et al. Papillary squamous cell carcinoma, not otherwise specified (NOS) of the penis: clinicopathologic features, differential diagnosis, and outcome of 35 cases. Am J Surg Pathol 2010; 34(2): 223–230. doi: 10.1097/PAS.0b013e3181c7666e.

30. Chaux A, Tamboli P, Ayala A et al. Warty-basaloid carcinoma: clinicopathological features of a distinctive penile neoplasm. Report of 45 cases. Mod Pathol 2010; 23(6): 896–904. doi: 10.1038/modpathol.2010.69.

31. Velazquez EF, Melamed J, Barreto JE et al. Sarcomatoid carcinoma of the penis: a clinicopathologic study of 15 cases. Am J Surg Pathol 2005; 29(9): 1152–1158.

32. Ficarra V, Akduman B, Bouchot O et al. Prognostic factors in penile cancer. Urology 2010; 76 (2 Suppl 1): S66–S73. doi: 10.1016/j.urology.2010.04.008.

33. Hughes B, Leijte J, Shabbir M et al. Non-invasive and minimally invasive staging of regional lymph nodes in penile cancer. World J Urol 2009; 27(2): ­197–203. doi: 10.1007/s00345-008-0288-6.

34. Agrawal A, Pai D, Ananthakrishnan N et al. Clinical and sonographic findings in carcinoma of the penis. J Clin Ultrasound 2000; 28(8): 399–406.

35. Esen G. Ultrasound of superficial lymph nodes. Eur J Radiol 2006; 58(3): 345–359.

36. Petralia G, Villa G, Scardino E et al. Local staging of penile cancer using magnetic resonance imag­ing with pharmacologically induced penile erection. Radiol Med 2008; 113(4): 517–528. doi: 10.1007/s11547-008-0273-6.

37. Velazquez EF, Barreto JE, Rodriguez I et al. Limitations in the interpretation of biopsies in pa­tients with penile squamous cell carcinoma. Int J Surg Pathol 2004; 12(2): 139–146.

38. Graafland NM, Leijte JA, Valdés Olmos RA et al. Scanning with 18F-FDG-PET/CT for detection of pelvic nodal involvement in inguinal node-positive ­penile carcinoma. Eur Urol 2009; 56(2): 339–345. doi: 10.1016/j.eururo.2009.05.016.

39. Jensen JB, Jensen KM, Ulh/oi BP et al. Sentinel ­lymph-node biopsy in patients with squamous cell carcinoma of the penis. BJU Int 2009; 103(9): ­1199–1203. doi: 10.1111/j.1464-410X.2009.08449.x.

40. Crawshaw JW, Hadway P, Hoffland D et al. Sentinel lymph node biopsy using dynamic lympho­scintigraphy combined with ultrasound-guided fine needle aspiration in penile carcinoma. Br J Radiol 2009; 82(973): 41–48. doi: 10.1259/bjr/99732265.

41. 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 2000; 85(3): 299–301.

42. Bissada NK, Yakout HH, Fahmy WE et al. Multi-institutional long-term experience with conservative surgery for invasive penile carcinoma. J Urol 2003; 169(2): 500–502.

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