Penile carcinoma accounts for 0.4-0.6% of malignant neoplasms in men, with incidence rising in older age groups and primarily manifesting as squamous cell carcinoma. Various premalignant lesions can develop, including bowenoid papulosis and leukoplakia, with treatment options ranging from excision to topical therapies. Risk factors include lack of circumcision, poor hygiene, and HPV infections, with the disease often presenting as ulcers, pain, or discharge, necessitating thorough examination and biopsy for diagnosis.

2. ANATOMY OF PENIS

4. PENILE CARCINOMA
 It accounts for 0.4-0.6% of all malignant
neoplasms among men in us and europe,it
represents upto 10% of malignant neoplasm in
asian,south american countries
 It is disease of olden men, incidences increases in
sixth decade of life
 More than 95% of lesions are squamous cell
carcinoma

5. PREMALIGNANT LESIONS
 Cutaneous Horn-rare solid skin over growth ,wide local excision done
 Bowenoid papulosis-multiple papules appears on penile skin or flat
glanular lesion
 Pseusoepitheliomatous micaceous and kerototic balanitits-unusual
hyperkeratotic growths on glans requires excision
 Condyloma acuminata- genital warts,soft multiple lesions on glans
prepuce and shaft
 Leukoplakia-solitary or multiple whitis glanular plaques involve
metus ,excision done
 Balanitis xerotica obliterans- also known as lichen sclerosus et
atrophicus seen over glans and prepuce
 Buschke lowenstein tumor-verucous ca ,aggressive locally advanced
tumor of the glans wide excision done
 Bowens disease-red cutaneous patch on the shaft of penis ,treatment
topical 5 FU,co2 laser ablation or surgical excision
 Erythroplasia of queyrat – red velvet circumscribed painless
lesion ,requires wide local excision

6. Bowenoid
papules
Cutaneous horn Condyloma acuminata
Erythroplasia
of queyrat

7. Buschke lowenstein tumor
 Invades locally
 Compresses the adjacent tissues causing urethral
erosion and fistulisation
 Never metastasis
 No sign of malignant change
 C/f bleeding discarge and foul odour
 Treatment is excision
 Laser is effective,topical 5-FU,

8. PENILE CARCINOMA
 Mc type is SCC {95%}
 Mesenchymal tumors{3%} like kaposi,angiosarcoma etc
 Basal cell ca,malignant melanoma,metastasis
 Carcinoma in situ: Tis of penis is called as erythroplasia
of queyrat it involves glans penis and prepuce
 It consists of red velvety well marginated lesions of glans
penis or may ulcerate with discharge
 Bowens disease it involves penile shaft or
perineum,characterized by sharply defined plaques of
scaly erythema on penile shaft

9.  Treatment
 Preputial lesion- circumcision or excision with
5mm margins
 Glanular lesion-topical 5 flurouracil cream or
ablation therapy
 Radiotherapy for resistant cases

10. Penile carcinoma
 Etiology
1.Lack of neonatal circumcision
2.Poor hygeine
3.Phimosis/BXO
4.Hpv infections
5.Exposure to tobacco products
6.Penile trauma mutilating circumcision,penile
tear

11.  Penile ca arises anywhere on penis but most
commonly on:
1. Glans 48%
2. Prepuce 21%
 Other tumors involve gans and prepuce 9% ,
coronal sulcus 6% and shaft <2%.

12. Presentation
 Begins as small lesion papillary and
exophytic/flat/ulcerative growth
 Lymphatic spread
 Flat&ulcerative lesions morethan 5 cm and
extending more than 75% of shaft have higher
incidence of metastasis and poor survival
 Bucks fascia protects corporeal invasion
 Distant metastasis uncommon
 Bladder and urethra involvement rare

13. CLINICAL FEATURES
 Patients present with swelling or ulcer on penis
 Pain is usually not a presenting complaints
 Weakness ,weight loss ,fatigue and significant blood loss from penile lesion or
nodal lesion
 Many present late by the time presentation it ranges from subtle induration to
small papule to warty or exophytic growth or ulcerative growth
 Phimosis may obscure lesion allow tumor progress Erosion through the
prepuce,foul smelling discharge with or without bleeding wit little or no pain
 Mass,ulceration,suppuration or hemorrage in the inguinal area due to
metastasis
 Urinary retention or urethral Fistula due to local corporeal involvement is
rare presentation
 Distant metastasis sites lung bone liver

14. EXAMINATION
 At presentation most of lesions are confined to penis
 penile lesion assesed with regard to size,location
fixation and involvement of corporeal bodies.
 Inspection of base of penis and scrotum too r/o
extension
 Rectal and bimanual examination provides info
regarding perineal body involvement and presence
of pelvic mass
 Bilateral palpation for inguinal area for adenopathy

15. Investigations
 Anemia,leucocytosis,hypercalcemia,hypoalbuminemia
 BIOPSY:confirmation of diagnosis
Asessment of depth of invasion,vascular invasion and
histological grade of the lesion mandatory before
initiating any therapy
 Dorsal slit is required for adequate exposure of lesion
 Histologically mostly are scc demonstrating
keratinization,epitelial pearly and degree of mitotic
activity
 Histological types includes 15% papillary,10% warty
and basaloid,3% verrucous and sarcomatoid
 Among these sarcomatoid and basloid (hpv
associaion)are aggresive

16. BRODERS CLASSIFICATION
 Used in scc to define level of differentiation on
basis of keratinization nuclear pleomorphism
and number of mitosis
 Low grade lesions(grade 1 nd 2) constitue 70-80%
these are well differentiated demonstrate keratin
keratin pearls
 High grade(grade 3 and 4) poorly differentiated
almosts orginates from shaft,10% located in the
prepuce

18. RADIOLOGICAL DIAGNOSIS
 CXR: for lung metastasis
 USG:cannot delineate invasion into subepithelial connective tissue of
glans penis from corpus spongiosum involvement
 CT SCAN: sensitivity and specificity of ct are 36% and 100%
Mainly for assessment of inguinal & pelvic lymph noe and secondaries
Ct guides biopsy of enlarged pelvic nodes
 MRI : sensitivity and specificity of 100% and 91%
1. Assesses local staging of tumor
2. Assessment of inguinal and pelvic LNs
3. Better with artificial erection
 Newer modalities
1. PET CT of inguinal region detects minimal inguinal metastasis when
lymph nodes are normal on ct/mri

22. TREATMENT
 Organ preservation
 Penile amputations
Organ preservation:
 Goal : to preserve glans sensation and to maximize
penile shaft length
Indication:
 primary tumor exhibiting favorable histologic
features
 Stages Tis ,Ta,T1 grade 1 and 2 tumors

24. Circumcision and limited excision
strategies:
1. 2 cm surgical margin required for all patients
undergoing partial penectomy
2. Maximum proximal histologic extent of 5mm for
grade1 and grade 2 tumors and 10mm for grade 3
tumors recommended
 Limitations:
1. proximal and distal deeply invasive tumors
2. High grade tumors
3. Skip lesions
4. Pts with poor compliance who would not be
candidate for salvage procedures
Recurrence rate is 4-6%

38. DASELER REGION
Inguinal region is divided into four sections by a horizontal and a vertical
line drawn through the fossa ovalis. Five anatomical subgroups with the
central zone being located at the confluence of the greater saphenous vein
and the femoral vein.