Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Carcinoma of the penis: Clinical presentation, diagnosis, and staging

Curtis A Pettaway, MD
Section Editor
Jerome P Richie, MD, FACS
Deputy Editor
Michael E Ross, MD


Carcinoma of the penis is rare in the United States, Europe, and other industrialized countries. However, the incidence of these malignancies is much higher in parts of South America, Africa, and Asia.

The clinical presentation, diagnosis, and staging of penile cancer are reviewed here. Related topics include:

(See "Carcinoma of the penis: Epidemiology, risk factors, and pathology".)

(See "Carcinoma of the penis: Surgical and medical treatment".)


The anatomic components of the penis include the following (figure 1):

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: May 04, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Ritchie AW, Foster PW, Fowler S, BAUS Section of Oncology. Penile cancer in the UK: clinical presentation and outcome in 1998/99. BJU Int 2004; 94:1248.
  2. Goodman MT, Hernandez BY, Shvetsov YB. Demographic and pathologic differences in the incidence of invasive penile cancer in the United States, 1995-2003. Cancer Epidemiol Biomarkers Prev 2007; 16:1833.
  3. 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; 113:2883.
  4. 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; 98:526.
  5. Favorito LA, Nardi AC, Ronalsa M, et al. Epidemiologic study on penile cancer in Brazil. Int Braz J Urol 2008; 34:587.
  6. Heyns CF, Mendoza-Valdés A, Pompeo AC. Diagnosis and staging of penile cancer. Urology 2010; 76:S15.
  8. STAUBITZ WJ, LENT MH, OBERKIRCHER OJ. Carcinoma of the penis. Cancer 1955; 8:371.
  9. RIVEROS M, GOROSTIAGA R. Cancer of the penis. Arch Surg 1962; 85:377.
  10. Derrick FC Jr, Lynch KM Jr, Kretkowski RC, Yarbrough WJ. Epidermoid carcinoma of the penis: computer analysis of 87 cases. J Urol 1973; 110:303.
  11. Johnson DE, Fuerst DE, Ayala AG. Carcinoma of the penis. Experience with 153 cases. Urology 1973; 1:404.
  12. Kossow JH, Hotchkiss RS, Morales PA. Carcinoma of penis treated surgically. Analysis of 100 cases. Urology 1973; 2:169.
  13. American Joint Committee on Cancer.. Penis.. In: American Joint Committee on Cancer, 7, Edge SB, Byrd DR, Compton CC (Eds), Springer, New York 2010. p.447.
  14. Buechner SA. Common skin disorders of the penis. BJU Int 2002; 90:498.
  15. Leis-Dosil VM, Alijo-Serrano F, Aviles-Izquierdo JA, et al. Angiokeratoma of the glans penis: clinical, histopathological and dermoscopic correlation. Dermatol Online J 2007; 13:19.
  16. Micali G, Innocenzi D, Nasca MR, et al. Squamous cell carcinoma of the penis. J Am Acad Dermatol 1996; 35:432.
  17. Jensen MO. Cancer of the penis in Denmark 1942 to 1962 (511 cases). Dan Med Bull 1977; 24:66.
  18. Boxer RJ, Skinner DG. Condylomata acuminata and squamous cell carcinoma. Urology 1977; 9:72.
  19. Smotkin D. Virology of human papillomavirus. Clin Obstet Gynecol 1989; 32:117.
  20. 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; 85:19.
  21. Mikhail GR. Cancers, precancers, and pseudocancers on the male genitalia. A review of clinical appearances, histopathology, and management. J Dermatol Surg Oncol 1980; 6:1027.
  22. Graham JH, Helwig EB. Erythroplasia of Queyrat. A clinicopathologic and histochemical study. Cancer 1973; 32:1396.
  23. Wieland U, Jurk S, Weissenborn S, et al. Erythroplasia of queyrat: coinfection with cutaneous carcinogenic human papillomavirus type 8 and genital papillomaviruses in a carcinoma in situ. J Invest Dermatol 2000; 115:396.
  24. Ikenberg H, Gissmann L, Gross G, et al. Human papillomavirus type-16-related DNA in genital Bowen's disease and in Bowenoid papulosis. Int J Cancer 1983; 32:563.
  25. Lucia MS, Miller GJ. Histopathology of malignant lesions of the penis. Urol Clin North Am 1992; 19:227.
  26. Schellhammer PF, Jordan GH, Robey EL, Spaulding JT. Premalignant lesions and nonsquamous malignancy of the penis and carcinoma of the scrotum. Urol Clin North Am 1992; 19:131.
  27. Gross G, Hagedorn M, Ikenberg H, et al. Bowenoid papulosis. Presence of human papillomavirus (HPV) structural antigens and of HPV 16-related DNA sequences. Arch Dermatol 1985; 121:858.
  28. Bonnekoh B, Mahrle G, Steigleder GK. [Transition to cutaneous squamous cell carcinoma in 2 patients with bowenoid papulomatosis]. Z Hautkr 1987; 62:773.
  29. Yoneta A, Yamashita T, Jin HY, et al. Development of squamous cell carcinoma by two high-risk human papillomaviruses (HPVs), a novel HPV-67 and HPV-31 from bowenoid papulosis. Br J Dermatol 2000; 143:604.
  30. Endo M, Yamashita T, Jin HY, et al. Detection of human papillomavirus type 16 in bowenoid papulosis and nonbowenoid tissues. Int J Dermatol 2003; 42:474.
  31. Patterson JW, Kao GF, Graham JH, Helwig EB. Bowenoid papulosis. A clinicopathologic study with ultrastructural observations. Cancer 1986; 57:823.
  32. Schwartz RA, Janniger CK. Bowenoid papulosis. J Am Acad Dermatol 1991; 24:261.
  33. Campus GV, Alia F, Bosincu L. Squamous cell carcinoma and lichen sclerosus et atrophicus of the prepuce. Plast Reconstr Surg 1992; 89:962.
  34. Pride HB, Miller OF 3rd, Tyler WB. Penile squamous cell carcinoma arising from balanitis xerotica obliterans. J Am Acad Dermatol 1993; 29:469.
  35. Barbagli G, Palminteri E, Mirri F, et al. Penile carcinoma in patients with genital lichen sclerosus: a multicenter survey. J Urol 2006; 175:1359.
  36. Depasquale I, Park AJ, Bracka A. The treatment of balanitis xerotica obliterans. BJU Int 2000; 86:459.
  37. Nasca MR, Innocenzi D, Micali G. Penile cancer among patients with genital lichen sclerosus. J Am Acad Dermatol 1999; 41:911.
  38. Lowe FC, McCullough AR. Cutaneous horns of the penis: an approach to management. Case report and review of the literature. J Am Acad Dermatol 1985; 13:369.
  39. Solivan GA, Smith KJ, James WD. Cutaneous horn of the penis: its association with squamous cell carcinoma and HPV-16 infection. J Am Acad Dermatol 1990; 23:969.
  40. Fields T, Drylie D, Wilson J. Malignant evolution of penile horn. Urology 1987; 30:65.
  41. PRESMAN D, ROLNICK D, TURBOW B. Penile horn. Am J Surg 1962; 104:640.
  42. Hassan AA, Orteza AM, Milam DF. Penile horn: review of literature with 3 case reports. J Urol 1967; 97:315.
  43. Bargman H. Pseudoepitheliomatous, keratotic, and micaceous balanitis. Cutis 1985; 35:77.
  44. Beljaards RC, van Dijk E, Hausman R. Is pseudoepitheliomatous, micaceous and keratotic balanitis synonymous with verrucous carcinoma? Br J Dermatol 1987; 117:641.
  45. Gray MR, Ansell ID. Pseudo-epitheliomatous hyperkeratotic and micaceous balanitis: evidence for regarding it as pre-malignant. Br J Urol 1990; 66:103.
  46. Child FJ, Kim BK, Ganesan R, et al. Verrucous carcinoma arising in pseudoepitheliomatous keratotic and micaceous balanitis, without evidence of human papillomavirus. Br J Dermatol 2000; 143:183.
  47. Pettaway CA, Srigley JR, Brookland RK, et al. Penis. In: AJCC Cancer Staging Manual, Eighth, Amin MB (Ed), 2017. p.701.
  48. Cubilla AL, Ayala A, Ayala G, et al. Malignant epithelial tumours. In: WHO Classification of Tumours of the Urinary System and Male Genital Organs, 8th, Moch H, Humphry PA, Ulbright TN, Reuter VE (Eds), WHO Press, Lyon 2016. Vol 8, p.262.
  49. 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; 113:517.
  50. Marconnet L, Rigaud J, Bouchot O. Long-term followup of penile carcinoma with high risk for lymph node invasion treated with inguinal lymphadenectomy. J Urol 2010; 183:2227.
  51. Ficarra V, Akduman B, Bouchot O, et al. Prognostic factors in penile cancer. Urology 2010; 76:S66.
  52. Sánchez-Ortiz RF, Pettaway CA. The role of lymphadenectomy in penile cancer. Urol Oncol 2004; 22:236.
  53. Leijte JA, Kirrander P, Antonini N, et al. Recurrence patterns of squamous cell carcinoma of the penis: recommendations for follow-up based on a two-centre analysis of 700 patients. Eur Urol 2008; 54:161.
  54. Delacroix SE Jr, Pettaway CA. Therapeutic strategies for advanced penile carcinoma. Curr Opin Support Palliat Care 2010; 4:285.
  55. Djajadiningrat RS, Teertstra HJ, van Werkhoven E, et al. Ultrasound examination and fine needle aspiration cytology-useful for followup of the regional nodes in penile cancer? J Urol 2014; 191:652.
  56. 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; 56:339.
  57. Saisorn I, Lawrentschuk N, Leewansangtong S, Bolton DM. Fine-needle aspiration cytology predicts inguinal lymph node metastasis without antibiotic pretreatment in penile carcinoma. BJU Int 2006; 97:1225.
  58. Kroon BK, Horenblas S, Deurloo EE, et al. Ultrasonography-guided fine-needle aspiration cytology before sentinel node biopsy in patients with penile carcinoma. BJU Int 2005; 95:517.
  59. Sadeghi R, Gholami H, Zakavi SR, et al. Accuracy of sentinel lymph node biopsy for inguinal lymph node staging of penile squamous cell carcinoma: systematic review and meta-analysis of the literature. J Urol 2012; 187:25.
  60. NCCN guidelines https://www.nccn.org/professionals/physician_gls/pdf/penile.pdf (Accessed on February 01, 2017).
  61. Graafland NM, Lam W, Leijte JA, et al. Prognostic factors for occult inguinal lymph node involvement in penile carcinoma and assessment of the high-risk EAU subgroup: a two-institution analysis of 342 clinically node-negative patients. Eur Urol 2010; 58:742.
  62. Kirrander P, Andrén O, Windahl T. Dynamic sentinel node biopsy in penile cancer: initial experiences at a Swedish referral centre. BJU Int 2013; 111:E48.
  63. Spiess PE, Hernandez MS, Pettaway CA. Contemporary inguinal lymph node dissection: minimizing complications. World J Urol 2009; 27:205.
  64. Matin SF, Cormier JN, Ward JF, et al. Phase 1 prospective evaluation of the oncological adequacy of robotic assisted video-endoscopic inguinal lymphadenectomy in patients with penile carcinoma. BJU Int 2013; 111:1068.
  65. Master VA, Jafri SM, Moses KA, et al. Minimally invasive inguinal lymphadenectomy via endoscopic groin dissection: comprehensive assessment of immediate and long-term complications. J Urol 2012; 188:1176.
  66. Catalona WJ. Modified inguinal lymphadenectomy for carcinoma of the penis with preservation of saphenous veins: technique and preliminary results. J Urol 1988; 140:306.
  67. Coblentz TR, Theodorescu D. Morbidity of modified prophylactic inguinal lymphadenectomy for squamous cell carcinoma of the penis. J Urol 2002; 168:1386.
  68. Colberg JW, Andriole GL, Catalona WJ. Long-term follow-up of men undergoing modified inguinal lymphadenectomy for carcinoma of the penis. Br J Urol 1997; 79:54.
  69. Hakenberg OW, Compérat EM, Minhas S, et al. EAU guidelines on penile cancer: 2014 update. Eur Urol 2015; 67:142.
  70. Graafland NM, Teertstra HJ, Besnard AP, et al. Identification of high risk pathological node positive penile carcinoma: value of preoperative computerized tomography imaging. J Urol 2011; 185:881.
  71. Graafland NM, van Boven HH, van Werkhoven E, et al. Prognostic significance of extranodal extension in patients with pathological node positive penile carcinoma. J Urol 2010; 184:1347.
  72. Pagliaro LC, Williams DL, Daliani D, et al. Neoadjuvant paclitaxel, ifosfamide, and cisplatin chemotherapy for metastatic penile cancer: a phase II study. J Clin Oncol 2010; 28:3851.
  73. NCCN Clinical Practice Guidelines in Oncology: Penile Cancer, v3, 2015. http://www.nccn.org/professionals/physician_gls/pdf/penile.pdf (Accessed on July 14, 2016).
  74. Ornellas AA, Kinchin EW, Nóbrega BL, et al. Surgical treatment of invasive squamous cell carcinoma of the penis: Brazilian National Cancer Institute long-term experience. J Surg Oncol 2008; 97:487.
  75. Pettaway CA, Pagliaro L, Theodore C, Haas G. Treatment of visceral, unresectable, or bulky/unresectable regional metastases of penile cancer. Urology 2010; 76:S58.