Penile tumours

Question 1

What cutaneous pre-cancerous lesions of the penis exist?

Answer 1

Balanitis xerotica obliterans (BXO)

leukoplakia

Question 2

BXO

• AKA
• what is this?
• what is this characterised by?
• where can this affect?
• what is the treatment?

Answer 2

Lichen sclerosis AKA atrophicus

This is whitish discolouration of the skin, that causes stiffness/tightness/difficulty to retract

Characterised by white patches, fissuring, bleeding, scarring

It can affect prepuce, glans, urethral extension

Needs surgical dilatation if causes stenosis of external urethral meatus
-may require glans resurfacing

Question 3

What different types of squamous carcinoma in situ of the penis exist?

Answer 3

• Erythroplasia of querat
• Bowens disease
• Red velvety patches

Question 4

What is erythroplasia of querat?

Answer 4

carcinoma in-situ of skin of glans/prepuce and shaft of penis

Question 5

What is bowens disease of penis?

Answer 5

this is erythroplasia of querat affects the remainder of the genitalia

Question 6

What are red velvety patches on the penis? how is this diagnosed? how is this treated?

Answer 6

NB zoons balanitis

• full thickness dysplasia of epidermis, resembles balanitis
• diagnosed via biopsy
• treat with local coagulation with a C02 laser or 5-fluorouracil cream or circumcision if prepuce alone

<5% are SCC

Question 7

SCC of penis:

• age range
• patient demographics

Answer 7

Age range: 80yrs

Demographics: rare in UK, common in latin america/africa/far east, occurs in uncircumcised men

Question 8

What is the presentation of SCC of penis?

Answer 8

• 50% delayed
• red, raised area glans/prepuce
• fungating mass
• foul smelling
• phimosis

ulcerating indurated tumour or exophytic mass

Question 9

what 3 things are included in the aetiology of SCC of penis?

Answer 9

• poor hygeine
• HPV 16
• SCC scrotum caused by occupational carcinogen exposure

Question 10

What is the diagnosis of SCC penis

Answer 10

If see a primary lesion with no regional disease/palpable nodes/distant mets:

• physical examination and cytological or histological diagnosis
• USS if suspected invasion corpora cavernosum
• MRI if USS inconclusive

If see regional disease/non palpable or palpable nodes - do a sentinel node biopsy

If there’s distant mets:
-pelvic and abdominal CT, CXR, bone scan if symptomatic

Question 11

How is SCC penis staged?

Answer 11

TNM

Question 12

What is the treatment of SCC penis?

Answer 12

Surgery:

• to treat primary tumour
• total/partial penectomy with reconstruction

Inguinal nodes:

• indicates prognosis/treatment options
• imaging radionuclide sentinel node biopsy
• inguinal lymphadenectomy

Radiotherapy:

• primary lesions
• lymph nodes
• chemo
• combined treatment