Intended for healthcare professionals

Clinical Review

Malignant and premalignant lesions of the penis

BMJ 2013; 346 doi: (Published 06 March 2013) Cite this as: BMJ 2013;346:f1149
  1. Manit Arya, senior lecturer and honorary consultant in urological oncology1,
  2. Jas Kalsi, consultant urologist 2,
  3. John Kelly, professor and consultant in urological oncology 3,
  4. Asif Muneer, consultant urological surgeon and andrologist 3
  1. 1University College Hospital, London, and Barts Cancer Institute, London, UK
  2. 2Wexham Park Hospital, Slough, UK
  3. 3University College Hospital, London, UK
  1. Correspondence to: M Arya manit_arya{at}
  • Accepted 7 February 2013

Summary points

  • Penile cancer has potentially devastating functional and psychological consequences for the patient

  • Penile cancer is thought to be associated with foreskin and genital infection with human papillomavirus types 16 and 18

  • Most patients present with a penile lump (47%), ulcer (35%), or erythematous lesion (17%)

  • Carcinoma in situ of the penis is treated initially with topical chemotherapy or lasers; surgery is reserved for unresponsive cases and men with extensive premalignant changes

  • In invasive penile cancer, penile preserving surgery minimises voiding and sexual dysfunction and psychological sequelae; more radical penile surgery is reserved for advanced cases

  • Metastatic inguinal lymph node involvement is the most important prognostic factor

Penile cancer can have devastating mutilating and psychological consequences for those affected. It is important for clinicians to be aware of the condition. Differentiation of benign genital dermatoses from premalignant penile lesions and early stage penile cancer, with prompt specialist referral, usually prevents progression, improves prognosis, and results in improved functional and cosmetic outcomes for affected men. A retrospective single centre study of all penile cancer cases in a specialist unit over five years found that general practitioners initiated most referrals, but that about 20% of patients were initially referred to specialties other than urology, such as genitourinary medicine, dermatology, or plastic surgery.1 This error delayed diagnosis by up to six months and potentially adversely affected quality of life, prognosis, and survival. Our article, written for the non-specialist, aims to provide an evidence based review of the causes and current trends in the diagnosis and management of premalignant and malignant penile lesions.

Sources and selection criteria

We searched PubMed to identify peer reviewed original articles, meta-analyses, and reviews. Search terms used were penile cancer, penile squamous cell cancer, penile neoplasm or neoplasia, risk factors for penile cancer, premalignant penile lesions, and prevention of penile cancer. We considered …

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