Squamous Cell Carcinoma of the Penis
Background. Squamous cell carcinoma of the penis is a rare malignancy in the United States, accounting for only 0.4% of all cancers in men.
Methods. From June 1975 to June 2000, 45 patients were diagnosed and treated for squamous cell carcinoma of the penis at our institution. Their medical records were reviewed retrospectively.
Results. The mean age at diagnosis was 63 years; 62% were white and 38% African American. Eighty-nine percent of our population was uncircumcised. Twenty patients had primary ilioinguinal lymph node dissections, with 11 positive for squamous cell carcinoma. Follow-up was documented for 42 patients, with a mean of 47 months. Four patients had local penile recurrence at a mean of 22 months after initial treatment. Nine patients had died of penile carcinoma at a mean of 18 months.
Conclusion. Squamous cell carcinoma of the penis accounts for 0.3% of malignancies in men seen at our institution. Nodal metastasis was a poor prognostic indicator. Although local penile recurrence was rare (8.8%), patients should be counseled on the importance of self-examination.

Squamous cell carcinoma of the penis is a rare malignancy, accounting for approximately 0.4% to 0.6% of all malignancies among men in the United States. It is most commonly diagnosed in the sixth and seventh decades of life, previous studies showing a mean age of 55 and 58 years. Prepubertal circumcision has been well established as a prophylactic measure that virtually eliminates the occurrence of squamous cell carcinoma of the penis. The development of squamous cell carcinoma of the penis in the uncircumcised male has been attributed to the chronic irritative effects of smegma. Previous studies have shown no prophylactic benefit of adult circumcision.

Treatment of the primary tumor has been well established, but management of the inguinal lymph nodes is controversial. Baker et al reviewed 5-year survival data on a series of 122 cases and concluded that prophylactic inguinal lymphadenectomy (clinically negative nodes) could not be justified. On the contrary, McDougal et al showed improved 5-year survival rates among patients having primary lymphadenectomy. These latter results were confirmed by Ornellas et al.

The current standard for management of the inguinal lymph nodes is directed at obtaining a possible surgical cure. In the patient with palpable inguinal adenopathy, a 4-week course of antibiotics should be initiated for possible reactive lymphadenopathy. We currently favor the management algorithm recommended by Lynch and Schellhammer. Patients with persistent bilateral adenopathy after antibiotic treatment should have total bilateral inguinal lymphadenectomy and pelvic lymphadenectomy. Patients with persistent unilateral adenopathy should have total inguinal lymphadenectomy on the involved side and superficial inguinal lymphadenectomy on the contralateral side, as well as pelvic lymphadenectomy. Patients without palpable lymph nodes should have primary bilateral superficial inguinal lymphadenectomy for stage T2 or greater or for moderately/poorly differentiated tumors.

The purpose of our study was to review our experience in diagnosing and treating squamous cell carcinoma of the penis. Results of treatment of the primary tumor were examined, including long-term outcomes after local excision and partial penectomy, emphasizing local recurrence rates as well as functionality. Management of the inguinal lymph nodes was also reviewed to determine impact on overall survival.