Penile Cancer and Penile Intraepithelial Neoplasia

Excerpt

Penile cancer is an uncommon malignancy that is psychologically devastating to the patient and can pose a challenge to clinicians. Patients with this condition tend to delay seeking medical attention due to embarrassment, guilt, fear, neglect, and denial. Additionally, the lesions are generally painless and do not typically cause erectile dysfunction or voiding difficulties in their early stages.

Patients often attempt to self-medicate with lotions, creams, or salves before seeking care. Up to 50% of patients with penile cancers will have delayed seeking medical attention for the lesion for up to 1 year. The delays in treatment may also be partly attributable to clinicians, as an estimated 25% of penile malignancies are diagnosed initially as benign lesions.

Many patients receive ointments, salves, and antibiotics from their clinician before seeing a urologist or dermatologist. The COVID-19 pandemic exacerbated this problem, especially as virtual visits are notoriously inadequate in evaluating penile lesions and possible carcinoma. This delay in diagnosis is quite serious, as it can decrease the likelihood of survival, increase morbidity, and limit the ability to retain a functioning, satisfactory result after surgical intervention.

The most common penile malignancy is squamous cell carcinoma, but nonsquamous malignant neoplasms of the penis also exist, including basal cell carcinomas, melanomas, sarcomas, metastatic cancers, and adenosquamous carcinomas. Premalignant penile lesions, formerly called Bowenoid papulosis, Bowen disease, erythroplasia of Queryrat, and squamous cell carcinoma in situ of the penis, are now classified as penile intraepithelial neoplasia. Bowenoid papulosis is often classified separately by dermatologists due to its generally benign and self-limiting course with a close clinical similarity to genital warts, even though histologically, it more closely resembles squamous cell carcinoma in situ. For more details on Bowenoid papulosis, see the companion StatPearls review on "Bowenoid Papulosis."

This activity focuses primarily on squamous cell carcinoma, including its etiology, epidemiology, pathophysiology, histopathology, evaluation, differential diagnosis, and treatment. The importance of the primary tumor's pathologic stage and histologic features, as well as the presence of lymph node metastases, in determining prognosis and treatment planning for squamous cell carcinoma are discussed. Treatment options and appropriate follow-up are covered in depth.