Editing Penile Cancer: Squamous Penile Cancer (section)

==== Lymph node involvement (pN+) ====
*'''Prognosis'''
**'''Pathologic criteria associated with improved long-term survival after attempted curative surgical resection of inguinal metastases include:'''
**# '''Unilateral involvement'''
**# '''Minimal nodal disease (≤2 involved nodes in most series (pN1))'''
**# '''No evidence of extra nodal extension of cancer (pN3)'''
**# '''Absence of pelvic nodal metastases (pN3)'''
**## '''i.e. pN1, and lack of features associated with pN2 and pN3'''
* '''No anatomic or lymphangiographic studies demonstrating direct lymphatic drainage to the pelvic lymph nodes from the penis, which is evidenced by the lack of metastatic spread to the pelvic lymph nodes from a primary penile tumor in the absence of metastatic spread to the inguinal lymph nodes[https://link.springer.com/book/10.1007/978-3-319-60858-7]'''
*'''<span style="color:#ff0000">Indications for pelvic lymph node dissection in patients undergoing inguinal lymph node dissection for curative intent (no pelvic adenopathy) (2):</span>'''
*# '''<span style="color:#ff0000">≥2 positive inguinal lymph nodes</span>'''
*# '''<span style="color:#ff0000">Extra-nodal extension is present</span>'''
*## '''PLND in this setting serves as staging tool to identify patients who should be considered for adjunctive therapy'''
*## '''PLND includes the distal common iliac, external iliac, and obturator groups of nodes.'''