Basal Cell Carcinoma, Melanoma & Sarcoma
- Basal cell carcinoma — common on sun-exposed skin but rare on the penis; local excision is virtually always curative.
- Melanoma — aggressive but curable if diagnosed and surgically treated early; surgery is the primary treatment, with radiation and chemotherapy only adjunctive or palliative.
- Sarcoma — prone to local recurrence, with rare regional/distant metastasis; superficial lesions can be treated with less radical procedures.
Extramammary Paget Disease
An erythematous, eczematoid, well-demarcated lesion that cannot be clinically distinguished from erythroplasia of Queyrat, Bowen disease, or penile CIS; it presents with local discomfort, pruritus, and occasionally serosanguineous discharge of the penis, scrotum, or perianal area. It behaves as a slow-growing intraepithelial adenocarcinoma that may become invasive, with dermal deposits spreading to regional nodes via dermal lymphatics. It may be associated with other GU malignancies (prostate, bladder, renal) — evaluate for these.
- Management — resect skin and dermis with a gross margin of up to 3 cm, using frozen sections to guide the extent; positive margins carry higher recurrence and warrant further resection. Cover defects with local skin or scrotal flaps; deeper invasion needs more extensive resection and reconstruction. Inguinal adenopathy warrants radical node dissection, though the prognosis is poor.
Other & Metastases
- Adenosquamous carcinoma and lymphoreticular malignant neoplasms also occur.
- Metastases to the penis usually represent spread from a clinically obvious primary, carry a poor prognosis, and are managed toward the primary histology with local palliation. Priapism is the most frequent sign of metastatic penile involvement, and lymphomatous infiltration is usually secondary to diffuse disease.
Self-Test
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What is the most frequent presenting sign of metastasis to the penis? Priapism.
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Which penile lesion mimics CIS clinically and may signal another GU cancer? Extramammary Paget disease — indistinguishable from erythroplasia of Queyrat/Bowen/CIS, and associated with prostate, bladder, or renal malignancies.
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What is the primary treatment for penile melanoma and sarcoma? Surgery — radiation and chemotherapy are only adjunctive or palliative for melanoma; sarcoma recurs locally but rarely metastasizes.