Squamous Cell Carcinoma of the Penis

Abstract

All squamous cell cancers of the penis are potentially lethal. Failure to cure these tumors almost always results from lack of control locally. Few patients die of distant metastases without extensive disease in the ilio-inguinal regions. This is similar to epidermoid cancers of the head and neck. Sometimes the primary lesion can be handled by local excision or by radiation therapy alone but usually the patient will require at least a partial penectomy. When partial penectomy has been adequate there have been remarkably few recurrences in the penile stump. Total penectomy should be reserved for large lesions with extensive involvement of the organ. Radiation therapy alone apparently is not a satisfactory way to treat patients with large primary lesions and suspected inguinal metastases. The statistics suggest that such patients are more likely to be cured by extended operation. The staging of these patients by means other than histologic examination of the nodes often is inaccurate. A biopsy of both sentinel lymph nodes indicates no immediate treatment if the nodes on both sides are free of tumor. An ilio-inguinal lymphadenectomy is performed on the side of a tumor-bearing sentinel node. More experience with this approach is required before it can be evaluated fully. Some physicians advocate delaying a lymphadenectomy until there is definite evidence of inguinal metastases. There are no data to prove that this is not satisfactory therapy. However, when lymphadenectomy is delayed the patient may be followed inadequately or lost to followup or inoperable disease may develop even while the patient is being watched. The controversy over whether operative treatment of the lymphatics should be limited to superficial groin dissections or whether ilio-inguinal lymphadenectomy should be done in every case is not resolved. A staged, bilateral, ilio-inguinal lymphadenectomy is advocated in almost all cases, using either the skin bridge technique or the 3-incision approach.