Penile cancer

Epidemiology
~1,000 cases per year in the US

Risk factors
Lack of circumcision
Phimosis
HPV

Anatomy: lymph drainage
Skin of penis: to bilateral superficial groin
Glans: to both superficial and deep groin nodes

Clinical
Most common site is prepuce/glans
35% of patients have involved nodes at diagnosis
Nodal risk is proportional to primary size and depth of invasion

Bowen's disease: carcinoma in situ of the penile shaft; 25-50% of patients have a concomitant visceral malignancy
Erythroplasia of Queyrat: epidermoid carcinoma in situ of the glans/prepuce

Prognostic factors
Most important is nodal status (80-90% of node negative patients are cured, 40-50% of patients with inguinal nodes, and 30% of those with pelvic nodes)

Therapy
Removal of primary and bilateral groin dissection (LND is diagnostic and therapeutic)