Carcinoma of the penis.

Most premalignant penile lesions should be completely locally excised. Giant condyloma frequently cannot be distinguished from fungating carcinoma and usually requires limited penectomy. Cancers other than epidermoid carcinomas are very rare and, except for basal cell carcinoma, have a generally poor prognosis. Prognosis of squamous cell carcinoma, however, depends on the stage of disease as determined by both local invasion and by involvement of inguinal nodes. The three-year survival rates for 55 patients were: stage I, 95 percent; stage II, 67 percent; stage III, 29 percent; and stage IV, zero percent. Most primary lesions were treated by partial penectomy, and no patient developed local recurrence. There is a significant discrepancy between initial clinical and histologic staging, due to the difficulty of determining lymph node metastases. Current methods of radiation therapy indicate that it has a role for management of primary penile cancer, especially in young men with small lesions. The management of inguinal lymph nodes is still debated. Although the reliability of the sentinel node biopsy has not been established, it may be appropriate in patients with noninvasive primary lesions and no detectable inguinal metastases. The need for immediate or prophylactic lymph node dissection in patients with invasive primary tumors is controversial. Successful management depends on careful and frequent follow-up examinations, with early intervention for suspicious adenopathy. In view of the poor prognosis for advanced lymph node metastases, we prefer to use early lymph node dissection when the primary lesion is deeply invasive. Limited bilateral pelvic lymph node dissection is associated with minimal morbidity and seems to be an appropriate prelude to groin dissection. Extensive pelvic metastases are a sign of incurability and abrogate the need for groin dissection. We prefer to perform the inguinal dissection at the time of lymph node dissection through a separate curve groin incision.