Editing EAU & ASCO: Penile Cancer 2023 (section)

=== Penile biopsy ===
* '''Indications'''
** '''Absolute'''
*** '''When malignancy is not clinically obvious, or when non-surgical treatment of the primary lesion is planned (e.g., topical agents, laser, radiotherapy).'''
** '''Relative'''
*** '''All suspected cases of penile cancer'''
**** '''Even in clinically obvious cases, histological information from a biopsy can facilitate treatment decisions (such as indications for surgical staging).'''
* '''Technique'''
** '''In most cases, acquiring a punch biopsy (e.g., 2–3 mm) under local anaesthesia is sufficient to confirm the diagnosis.'''
** '''in cases where assessment of depth of invasion is necessary, an incisional biopsy which is deep enough to properly assess the degree of invasion and stage is preferable.'''
** Tissue sections determine the accuracy of histological diagnosis. 
*** Small lesions should be fully included
*** Bigger lesions should have at least 3-4 blocks of tumour with the anatomical landmarks
* Second-opinion pathology review is recommended given the rarity of this cancer
* The pathology report must include 
** Surgical procedure
** Anatomical site of the primary tumour
** Size of tumour
** Maximum thickness
** Histological type of SCC
** Grade
** Depth and extent of invasion
** Vascular invasion (venous/lymphatic)
** Perineural invasion
** Surgical margins
** HPV assessment