There are two opposing schools of thought regarding the management of pigmented penile macules. Allan and Spitz, as well as Pack and Davis, are of the opinion that almost all pigmented naevi present on the palms, soles and genitalia are junctional naevi and have a higher incidence of malignant change and, therefore, should be removed. On the other hand, because most cases of penile and urethral melanomas arise de novo with only a few arising from previous long-standing naevi and as precursor lesions are not identified in most cases, Scott et al. and Stegmaire et al. consider prophylactic excision unnecessary. A more practical approach has been taken up by Barnhill et al. and their view is that management should be individualized with multiple biopsies to establish the diagnosis. The purpose of this paper is to review the literature regarding the natural history, risk of melanoma development on the penis and the management of cases presenting with pigmented penile macules.