• Penile cancer has potentially devastating functional and psychological consequences for the patient
• Penile cancer is thought to be associated with foreskin and genital infection with human papillomavirus types 16 and 18
• Most patients present with a penile lump (47%), ulcer (35%), or erythematous lesion (17%)
• Carcinoma in situ of the penis is treated initially with topical chemotherapy or lasers; surgery is reserved for unresponsive cases and men with extensive premalignant changes
• In invasive penile cancer, penile preserving surgery minimises voiding and sexual dysfunction and psychological sequelae; more radical penile surgery is reserved for advanced cases
• Metastatic inguinal lymph node involvement is the most important prognostic factor

Penile cancer can have devastating mutilating and psychological consequences for those affected. It is important for clinicians to be aware of the condition. Differentiation of benign genital dermatoses from premalignant penile lesions and early stage penile cancer, with prompt specialist referral, usually prevents progression, improves prognosis, and results in improved functional and cosmetic outcomes for affected men. A retrospective single centre study of all penile cancer cases in a specialist unit over five years found that general practitioners initiated most referrals, but that about 20% of patients were initially referred to specialties other than urology, such as genitourinary medicine, dermatology, or plastic surgery.1This error delayed diagnosis by up to six months and potentially adversely affected quality of life, prognosis, and survival. Our article, written for the non-specialist, aims to provide an evidence based review of the causes and current trends in the diagnosis and management of premalignant and malignant penile lesions.

Source:BMJ