Penile cancer is uncommon, but, when it is diagnosed, it is psychologically devastating to the patient and often presents a challenge to the urologist. Benign, premalignant, and malignant conditions must be differentiated. Penile squamous cell carcinoma (see image below), the most common penile malignancy, behaves similarly to squamous cell carcinoma in other parts of the skin. Metastasis, which occurs with this type of carcinoma when the diagnosis or treatment is delayed, is usually lethal. This is a slow-growing cancer in its early stages, and because it seldom interferes with voiding or erectile function, patients do not complain until pain or a discharge from the cancer occurs. By this time, the cancer has usually progressed from being superficial to invasive.
Patients with carcinoma of the penis tend to delay seeking medical attention, with 15-50% delaying medical attention for more than 1 year from onset. This delay is attributed to embarrassment, guilt, fear, ignorance, and personal neglect. Patients often try to treat themselves with various skin creams and lotions. These may appear to be effective for a time, which further delays the diagnosis and worsens the prognosis.
Delays may also attributable to the physician. Some patients with penile cancer report that they received various salves and antibiotics from their primary care physicians before they saw an urologist. A delay in diagnosis and therapy not only affects the likelihood of survival but also limits the ability to retain a functioning and cosmetically satisfactory result. Nearly 25% of dysplastic or neoplastic penile lesions are misdiagnosed as being benign.
A biopsy should be considered in any uncircumcised male who presents with a penile lesion. These tend to originate on the glans penis and the undersurface of the prepuce. Many benign conditions may be found in this area, and only a biopsy can clarify the diagnosis.