Editing EAU & ASCO: Penile Cancer 2023 (section)

=== History and Physical Exam ===

==== History ====

* '''Risk factors for penile cancer (see above)'''

==== Physical exam ====

===== Penis/foreskin =====
* Often presents as raised or ulcerous lesions which can be locally destructive
** '''Can sometimes be hidden under the foreskin/prepuce in case of phimosis'''
** Most PeIN lesions are located on the mucosal surfaces of the glans or prepuce
*** Lichen sclerosus also affects the foreskin/prepuce
* Note the dimensions, anatomic location, and extent of local invasion
* Examine entire penis to identify potential skip lesions
* Assess stretched penile length

===== Inguinal lymph nodes =====
* '''<span style="color:#ff0000">False-negative'''
** '''<span style="color:#ff0000">Reliable physical examination can be challenging in case of obesity and in patients with previous inguinal surgery'''
* '''<span style="color:#ff0000">False-positive'''
** '''<span style="color:#ff0000">Enlarged LNs secondary to infection of the primary tumour (rather than metastasis) can occur'''
*** '''Use of antibiotics with the aim to resolve enlarged nodes may delay further staging and treatment and is not recommended'''
* '''<span style="color:#ff0000">Based on physical examination, patients can be divided into (2)''' 
** '''<span style="color:#ff0000">Those without suspicious nodes at physical examination (clinically node-negative, cN0),'''
** '''<span style="color:#ff0000">Those with suspicious palpable nodes (clinically node-positive, cN+).''' 
*** In case of suspected pathologic LNs at palpation; the number, location, size and whether the node is fixed or mobile, should be noted.