Penile Cancer: Non-squamous Penile Cancer

• Non-squamous penile cancer is extremely rare

Basal cell carcinoma

• Frequently encountered on other sun-exposed cutaneous surfaces, it is rare on the penis
• Treatment is by local excision, which is virtually always curative

Melanoma

• Aggressive form of cancer but can be cured if diagnosed and treated with the appropriate surgical treatment at an early stage
  • Surgery is the primary mode of treatment; radiation therapy and chemotherapy are of only adjunctive or palliative benefit

Sarcoma

• Prone to local recurrence; regional and distant metastases are rare.
• Superficial lesions can be treated with less radical procedures

Extramammary Paget Disease

• Appearance
  • Erythematous, eczematoid, well-demarcated area
  • Cannot be clinically distinguished from erythroplasia of Queyrat, Bowen disease, or carcinoma in situ of the penis
  • See Figure
• Clinical presentation
  • Local discomfort, pruritus, and occasionally a serosanguineous discharge involving the penis, the scrotum, or even the perianal area
• Behaves as a slow-growing intraepithelial adenocarcinoma
  • With time the cells may become invasive with dermal tumor deposits metastasizing to regional lymph nodes via dermal lymphatics penoscrotal
• May be associated with other malignancies of the genitourinary tract, such as prostate, bladder, and renal malignancies and should be evaluated for their presence
• Management
  • In most cases, only the skin and dermis must be resected with a gross margin of up to 3 cm. Positive margins may still occur, and frozen sections are recommended to guide the extent of resection.
    • Patients with a positive surgical margin are at a higher risk for recurrence, and additional resection is advised
  • Local skin or scrotal flaps can be used to cover the defects.
  • In a minority of cases the tumor may invade deeper structures, necessitating more extensive resection and reconstruction
  • If inguinal adenopathy is present, radical node dissection is advised but prognosis is poor

Metastases

• Most often represent spread from a clinically obvious existing primary tumor.
• Prognosis is poor, and therapy should be directed toward the primary tumor site histology and local palliation
• Priapism is the most frequently encountered sign of metastatic involvement of the penis

Lymphomatous infiltration of the penis is most likely secondary to diffuse disease

References

• Wein AJ, Kavoussi LR, Partin AW, Peters CA (eds): CAMPBELL-WALSH UROLOGY, ed 11. Philadelphia, Elsevier, 2015