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Author: Admin | 2025-04-28
A). The lesions are generally 2 to 35 mm and occur on the glans penis, urethral meatus, frenulum, coronal sulcus, or prepuce. In uncircumcised patients, the lesions may be crusted without a velvety red appearance. Lesions on the shaft may appear erythematous, display fissuring, and have soft, white scales. Penile carcinoma in situ requires biopsy to distinguish it from psoriasis and Zoon balanitis.8,67–69 Penile carcinoma in situ lesions restricted to the prepuce are treated with circumcision.70,71 Mohs micrographic surgery may be indicated for recurrence or incompletely excised lesions.63,71 Treatment with fluorouracil, curettage, local excision, laser ablation, or photodynamic therapy is associated with significant recurrence rates and requires thorough follow-up (repeat physical examinations and rebiopsy as clinically suspected).62,71 Radiation may be an option for patients who are not surgical candidates or who refuse surgery. Imiquimod is an immune response modifier that has also been studied for penile carcinoma in situ with mixed results.63,64,72,73 INVASIVE SQUAMOUS CELL CARCINOMA Penile cancer is rare, with a prevalence of two or three cases per 100,000 men.66 The peak incidence is in men older than 70 years.66 Squamous cell carcinoma accounts for 95% of penile cancers.63,66 Risk factors include human papillomavirus infection, lichen sclerosus, smegma, smoking, older age, poor hygiene, presence of the prepuce, and phimosis.8,31,63 Giant condyloma (Figure 8A3 ) may be difficult to distinguish from squamous cell carcinoma (Figure 8B3 ), and biopsy is indicated if the diagnosis is in doubt. Wart-like lesion types. (A) giant conyloma that looks similar to squamous cell carcinoma. (B) Invasive squamous cell carcinoma.Reprinted with permission from Teichman JM, Sea J, Thompson IM, Elston DM. Noninfectious penile lesions. Am Fam Physician. 2010;81(2):172-173."> Given that, on average, patients with squamous cell carcinoma of the penis delay seeking medical care by six months or longer, presentations can vary.66,74,75 It can appear as a painless lump or ulcer that progresses to thickened skin and a wart-like growth, sometimes with a foul discharge (eFigure D and eFigure E). Rashes and skin coloration changes may occur.76 Exophytic or fungating squamous cell carcinoma typically appears as a large, irregularly shaped mass, whereas endophytic squamous cell carcinoma commonly presents as ulcerative and infiltrative lesions.66,77 Exophytic lesions occasionally lead to phimosis requiring prepuce retraction for mass visualization (eFigure F and eFigure G). Verrucous carcinoma with thickened skin and wart-like growth, with similarity to giant condyloma."> Squamous cell carcinoma of the glans penis with heterogeneous, irregular mass and discharge."> Phimosis conceals underlying mass.Reprinted with permission from Teichman JM, Sea J, Thompson IM, Elston DM. Noninfectious penile lesions. Am Fam Physician . 2010;81(2):173."> Exophytic lesion is easily visible upon retraction of the prepuce."> The diagnosis of squamous cell carcinoma is confirmed on biopsy.66 In general, low-grade and low-stage tumors
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