Abstract:
The majority of penile carcinoma is squamous cell carcinoma. Although uncommon in the United States, it represents a larger proportion of cancers in the underdeveloped world. Invasive squamous cell carcinoma may arise from precursor lesions or de novo , and has been associated with lack of circumcision and HPV infection. Early diagnosis is imperative as lymphatic spread is associated with a poor prognosis. Radical surgical treatment is no longer the mainstay, and penile sparing treatments now are often used, including Mohs micrographic surgery. Therapeutic decisions should be made with regard to the size and location of the tumor, as well as the functional desires of the patient. It is critical for the dermatologist to be familiar with the evaluation, grading/staging, and treatment advances of penile squamous cell carcinoma. Herein, we present a review of the literature regarding penile squamous cell carcinoma, as well as a case report of invasive squamous cell carcinoma treated with Mohs micrographic surgery.
Keywords:
Carcinoma, squamous cell; Mohs surgery; Penile neoplasms; Penis
INTRODUCTION
Penile cancer is a rare diagnosis in the United States and other developed nations. In the United States in 2015, the American Cancer Society predicted 1,820 new cases with 310 penile cancer deaths.11 American Cancer Society. Cancer Facts and Figures 2015. Atlanta, Ga: American Cancer Society; 2015. [cited 2015 May 12]. Available from: http://www.cancer.org/cancer/penilecancer/detailedguide/penile-cancer-key-statistics
http://www.cancer.org/cancer/penilecance...
However, the disease is more common in developing countries, where it may represent up to 10% of cancers in males.22 Pow-Sang MR, Ferreira U, Pow-Sang JM, Nardi AC, Destefano V. Epidemiology and natural history of penile cancer. Urology. 2010;76:S2-6.,33 Barnholtz-sloan JS, Maldonado JL, Pow-sang J, Giuliano AR, Guiliano AR. Incidence trends in primary malignant penile cancer. Urol Oncol. 2007;25:361-7.,44 Brady KL, Mercurio MG, Brown MD. Malignant tumors of the penis. Dermatol Surg. 2013;39:527-47. The majority of penile cancer is squamous cell carcinoma (SCC).55 Burt LM, Shrieve DC, Tward JD. Stage presentation, care patterns, and treatment outcomes for squamous cell carcinoma of the penis. Int J Radiat Oncol Biol Phys. 2014;88:94-100.
The pathogenesis of penile cancer is not entirely known. SCC may evolve from penile intraepithelial neoplasia (PIN) or arise de novo .44 Brady KL, Mercurio MG, Brown MD. Malignant tumors of the penis. Dermatol Surg. 2013;39:527-47. Penile SCC has been associated with high-risk HPV infections, most commonly strains 16 and 18. The mechanism through which HPV leads to penile cancer is most likely mediated through viral oncogenes E6 and E7, which are actively transcribed by HPV-infected cells. Viral oncogene E6 targets p53 and viral oncogene E7 targets RB1; both p53 and RB1 are tumor suppressor genes, which are negative regulators of cell proliferation. When these genes are transformed, this may lead to unchecked proliferation and subsequent development of malignancy.33 Barnholtz-sloan JS, Maldonado JL, Pow-sang J, Giuliano AR, Guiliano AR. Incidence trends in primary malignant penile cancer. Urol Oncol. 2007;25:361-7. HPV-DNA has been found in only 22-72% of penile SCC, but has been identified in the vast majority of PIN (70-100%).33 Barnholtz-sloan JS, Maldonado JL, Pow-sang J, Giuliano AR, Guiliano AR. Incidence trends in primary malignant penile cancer. Urol Oncol. 2007;25:361-7. This discordance between the presence of HPV-DNA in SCC versus PIN suggests an HPV independent and dependent etiology for the development of SCC.44 Brady KL, Mercurio MG, Brown MD. Malignant tumors of the penis. Dermatol Surg. 2013;39:527-47.
The prevalence of genital HPV-DNA in men is 1.3% to 72.9%, with a mean of >20% reported by most studies.66 Dunne EF, Nielson CM, Stone KM, Markowitz LE, Giuliano AR. Prevalence of HPV infection among men: a systematic review of the literature. J Infect Dis. 2006;194:1044-57. In several cohort studies, it is estimated that most HPV infections in men clear in less than 12 months, with a median of 5.9 to 7.5 months.77 Lu B, Wu Y, Nielson CM, Flores R, Abrahamsen M, Papenfuss M, et al. Factors associated with acquisition and clearance of human papillomavirus infection in a cohort of US men: a prospective study. J Infect Dis. 2009;199:362-71.,88 Giuliano AR, Lee JH, Fulp W, Villa LL, Lazcano E, Papenfuss MR, et al. Incidence and clearance of genital human papillomavirus infection in men (HIM): a cohort study. Lancet. 2011;377:932-40. Increasing age and fewer numbers of female partners are positively correlated with a greater probability of clearing an HPV infection.88 Giuliano AR, Lee JH, Fulp W, Villa LL, Lazcano E, Papenfuss MR, et al. Incidence and clearance of genital human papillomavirus infection in men (HIM): a cohort study. Lancet. 2011;377:932-40. The development of the quadrivalent HPV vaccine to high-risk strains 6, 11, 16, and 18, has been shown to significantly reduce HPV-associated genital disease in men, including genital warts, with an efficacy of 89.4%.99 Giuliano AR, Palefsky JM, Goldstone S, Moreira ED Jr, Penny ME, Aranda C, et al. Efficacy of quadrivalent HPV vaccine against HPV Infection and disease in males. N Engl J Med. 2011;364:401-11. The use of the HPV vaccine in males has the potential to significantly reduce the incidence of penile cancer, among other disfiguring genital lesions such as condylomas and genital warts.
Penile SCC occurs almost exclusively in uncircumcised men.33 Barnholtz-sloan JS, Maldonado JL, Pow-sang J, Giuliano AR, Guiliano AR. Incidence trends in primary malignant penile cancer. Urol Oncol. 2007;25:361-7. Neonatal circumcision is implicated as strongly protective against penile cancer.1010 Larke NL, Thomas SL, dos Santos Silva I, Weiss HA. Male circumcision and penile cancer: a systematic review and meta-analysis. Cancer Causes Control. 2011;22:1097-110.,1111 Morris BJ, Gray RH, Castellsague X, Bosch FX, Halperin DT, Waskett JH, et al. The Strong Protective Effect of Circumcision against Cancer of the Penis. Adv Urol. 2011;2011:812368. Proposed etiological factors associated with an intact foreskin are smegma and phimosis. Smegma is a product of desquamating epithelial cells and bacterial byproducts found between the glans penis and foreskin.1111 Morris BJ, Gray RH, Castellsague X, Bosch FX, Halperin DT, Waskett JH, et al. The Strong Protective Effect of Circumcision against Cancer of the Penis. Adv Urol. 2011;2011:812368. Smegma-induced chronic inflammation may predispose to the development of phimosis as well as SCC.44 Brady KL, Mercurio MG, Brown MD. Malignant tumors of the penis. Dermatol Surg. 2013;39:527-47. Phimosis, the inability to retract the foreskin over the glans, has been found in 25-60% of patients with penile cancer.33 Barnholtz-sloan JS, Maldonado JL, Pow-sang J, Giuliano AR, Guiliano AR. Incidence trends in primary malignant penile cancer. Urol Oncol. 2007;25:361-7.,44 Brady KL, Mercurio MG, Brown MD. Malignant tumors of the penis. Dermatol Surg. 2013;39:527-47. It is associated with an increased incidence of infection as well as dysplastic changes of the preputial sac.1212 Reddy CR, Devendranath V, Pratap S. Carcinoma of penis--role of phimosis. Urology. 1984;24:85-8. Further, uncircumcised men have been found to be at an increased risk of HPV infection when compared to their circumcised counterparts.1313 Castellsagué X, Bosch FX, Muñoz N, Meijer CJ, Shah KV, de Sanjose S, et al. Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. N Engl J Med. 2002;346:1105-12. Additional risk factors associated with the development of penile SCC include smoking, HIV infection, poor genital hygiene, previous injury to the penis, chronic balanitis, lichen sclerosis et atrophicus, and psoralen plus ultraviolet A treatment to the area.33 Barnholtz-sloan JS, Maldonado JL, Pow-sang J, Giuliano AR, Guiliano AR. Incidence trends in primary malignant penile cancer. Urol Oncol. 2007;25:361-7.,44 Brady KL, Mercurio MG, Brown MD. Malignant tumors of the penis. Dermatol Surg. 2013;39:527-47.,1414 Spiess PE, Horenblas S, Pagliaro LC, Biagioli MC, Crook J, Clark PE, et al. Current concepts in penile cancer. J Natl Compr Canc Netw. 2013;11:617-24
Penile SCC most commonly presents between the ages of 50 and 70 years.33 Barnholtz-sloan JS, Maldonado JL, Pow-sang J, Giuliano AR, Guiliano AR. Incidence trends in primary malignant penile cancer. Urol Oncol. 2007;25:361-7. The majority of lesions are found on the glans (48%), followed by the prepuce (21%), both glans and prepuce (15%), coronal sulcus (6%), and shaft (<2%).33 Barnholtz-sloan JS, Maldonado JL, Pow-sang J, Giuliano AR, Guiliano AR. Incidence trends in primary malignant penile cancer. Urol Oncol. 2007;25:361-7. Clinical presentation is variable. It may present as a small area of induration and erythema or a large ulcerating and infiltrative lesion. As the disease progresses, there may be associated itching, bleeding, discharge, foul odor, and pain.33 Barnholtz-sloan JS, Maldonado JL, Pow-sang J, Giuliano AR, Guiliano AR. Incidence trends in primary malignant penile cancer. Urol Oncol. 2007;25:361-7. Presentation may be delayed secondary to psychological factors, with an estimated 15 to 60% of patients postponing presentation for at least one year.33 Barnholtz-sloan JS, Maldonado JL, Pow-sang J, Giuliano AR, Guiliano AR. Incidence trends in primary malignant penile cancer. Urol Oncol. 2007;25:361-7.,44 Brady KL, Mercurio MG, Brown MD. Malignant tumors of the penis. Dermatol Surg. 2013;39:527-47. Despite this, most men (66%) initially present with localized disease.44 Brady KL, Mercurio MG, Brown MD. Malignant tumors of the penis. Dermatol Surg. 2013;39:527-47. Assessment of lymphatic spread with palpation of inguinal lymph nodes is an essential component of the initial physical exam. Lymphatic spread usually occurs in a predictable course, first to the superficial and deep inguinal nodes, followed by the pelvic, and then periaortic nodes.1515 McDougal WS, Lee RJ, Efstathiou JA, Harisinghani M, Wu CL. Case records of the Massachusetts General Hospital. Case 2-2014. A 44-year-old man with a lesion on the penis. N Engl J Med. 2014;370:263-71. Distant metastases are generally uncommon (1-10%) and occur late in the disease.33 Barnholtz-sloan JS, Maldonado JL, Pow-sang J, Giuliano AR, Guiliano AR. Incidence trends in primary malignant penile cancer. Urol Oncol. 2007;25:361-7.,1515 McDougal WS, Lee RJ, Efstathiou JA, Harisinghani M, Wu CL. Case records of the Massachusetts General Hospital. Case 2-2014. A 44-year-old man with a lesion on the penis. N Engl J Med. 2014;370:263-71.
Differential diagnostic considerations of penile SCC include premalignant and malignant lesions, infections, and inflammatory conditions. Neoplastic lesions such as erythroplasia of Queyrat, Bowen's disease or Bowenoid papulosis should be considered.44 Brady KL, Mercurio MG, Brown MD. Malignant tumors of the penis. Dermatol Surg. 2013;39:527-47. Condyloma acuminata may resemble SCC, especially the verrucous variant. Ulceration and lymphadenopathy may raise concern for the chancre of a primary syphilis infection or the chancroid of Haemophilus ducreyi. Additionally, the psoriatic scales and plaques of genital psoriasis and violaceous lesions of lichen planus may appear clinically similar to SCC.1414 Spiess PE, Horenblas S, Pagliaro LC, Biagioli MC, Crook J, Clark PE, et al. Current concepts in penile cancer. J Natl Compr Canc Netw. 2013;11:617-24
Penile SCC can be divided into several subtypes. The most common subtypes include usual SCC (48-65%), basaloid carcinoma (4-10%), warty carcinoma (7-10%), verrucous carcinoma (3-8%), papillary carcinoma (5-15%), and mixed carcinomas (9-10%).1616 Chaux A, Cubilla AL. Advances in the pathology of penile carcinomas. Hum Pathol. 2012;43:771-89. Each subtype has distinct histologic features. Histopathologic analysis is used to grade the tumor, which is then assigned on a spectrum based on cellular differentiation (Chart 1).1414 Spiess PE, Horenblas S, Pagliaro LC, Biagioli MC, Crook J, Clark PE, et al. Current concepts in penile cancer. J Natl Compr Canc Netw. 2013;11:617-24,1616 Chaux A, Cubilla AL. Advances in the pathology of penile carcinomas. Hum Pathol. 2012;43:771-89.,1717 Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer; 2010. Staging is performed using the TNM penile cancer system developed by the American Joint Committee on Cancer (Chart 2).1717 Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer; 2010. Staging is based on depth of tumor invasion, nodal involvement, and distant metastases (Chart 3).1717 Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer; 2010.
Surgical decisions should be made with regard to the size and location of the tumor, as well as the functional desires of the patient. For patients with PIN, topical imiquimod or 5-fluorouracil, circumcision and local excision, and laser ablative therapy could be used as penile preserving techniques.1414 Spiess PE, Horenblas S, Pagliaro LC, Biagioli MC, Crook J, Clark PE, et al. Current concepts in penile cancer. J Natl Compr Canc Netw. 2013;11:617-24 When treating patients with well- to moderately-differentiated T1 SCC tumors, penile sparing surgery should be utilized.1414 Spiess PE, Horenblas S, Pagliaro LC, Biagioli MC, Crook J, Clark PE, et al. Current concepts in penile cancer. J Natl Compr Canc Netw. 2013;11:617-24 In these stage I tumors, wide local excision using 2 cm margins has been traditionally used; however, smaller 5 to 10 mm margins have shown low recurrence rates.1414 Spiess PE, Horenblas S, Pagliaro LC, Biagioli MC, Crook J, Clark PE, et al. Current concepts in penile cancer. J Natl Compr Canc Netw. 2013;11:617-24 Mohs micrographic surgery (MMS) is becoming increasingly popular and has the ability to provide superior aesthetic results with preservation of normal surrounding tissue.1515 McDougal WS, Lee RJ, Efstathiou JA, Harisinghani M, Wu CL. Case records of the Massachusetts General Hospital. Case 2-2014. A 44-year-old man with a lesion on the penis. N Engl J Med. 2014;370:263-71.,1818 Shindel AW, Mann MW, Lev RY, Sengelmann R, Petersen J, Hruza GJ, et al. Mohs micrographic surgery for penile cancer: management and long-term followup. J Urol. 2007;178:1980-5.,1919 Wells MJ, Taylor RS. Mohs micrographic surgery for penoscrotal malignancy. Urol Clin North Am. 2010;37:403-9.
A great advantage of using MMS is removal of the tumor with complete visualization to ensure negative margins.1818 Shindel AW, Mann MW, Lev RY, Sengelmann R, Petersen J, Hruza GJ, et al. Mohs micrographic surgery for penile cancer: management and long-term followup. J Urol. 2007;178:1980-5.,1919 Wells MJ, Taylor RS. Mohs micrographic surgery for penoscrotal malignancy. Urol Clin North Am. 2010;37:403-9. For penile SCC, MMS is most successful in smaller tumors with lower grade.1818 Shindel AW, Mann MW, Lev RY, Sengelmann R, Petersen J, Hruza GJ, et al. Mohs micrographic surgery for penile cancer: management and long-term followup. J Urol. 2007;178:1980-5. If urethral involvement is present, MMS should be discouraged.1919 Wells MJ, Taylor RS. Mohs micrographic surgery for penoscrotal malignancy. Urol Clin North Am. 2010;37:403-9. Patients with tumors staged II and above are usually not candidates for penile sparing therapy due to larger tumor size and further depth of invasion.1414 Spiess PE, Horenblas S, Pagliaro LC, Biagioli MC, Crook J, Clark PE, et al. Current concepts in penile cancer. J Natl Compr Canc Netw. 2013;11:617-24,1515 McDougal WS, Lee RJ, Efstathiou JA, Harisinghani M, Wu CL. Case records of the Massachusetts General Hospital. Case 2-2014. A 44-year-old man with a lesion on the penis. N Engl J Med. 2014;370:263-71. Partial or total penectomy should be considered in these patients. Concern should be taken for preservation of urination and sexual function.2020 Kieffer JM, Djajadiningrat RS, van Muilekom EA, Graafland NM, Horenblas S, Aaronson NK. Quality of life in patients treated for penile cancer. J Urol. 2014;192:1105-10. Radiation and chemotherapy could be used as adjuvant therapy or in cases of palliation.1515 McDougal WS, Lee RJ, Efstathiou JA, Harisinghani M, Wu CL. Case records of the Massachusetts General Hospital. Case 2-2014. A 44-year-old man with a lesion on the penis. N Engl J Med. 2014;370:263-71.
Evaluation of lymphatic spread is critical and guidelines are still emerging.55 Burt LM, Shrieve DC, Tward JD. Stage presentation, care patterns, and treatment outcomes for squamous cell carcinoma of the penis. Int J Radiat Oncol Biol Phys. 2014;88:94-100. About 28-64% of patients will present with palpable inguinal nodes.2121 Ficarra V, Akduman B, Bouchot O, Palou J, Tobias-Machado M. Prognostic factors in penile cancer. Urology. 2010;76:S66-73. However, of these, 47-85% will have metastatic disease, with the remainder of nodal enlargement secondary to inflammation.44 Brady KL, Mercurio MG, Brown MD. Malignant tumors of the penis. Dermatol Surg. 2013;39:527-47.,2121 Ficarra V, Akduman B, Bouchot O, Palou J, Tobias-Machado M. Prognostic factors in penile cancer. Urology. 2010;76:S66-73. Even in patients without palpable nodes, an estimated 25% will still have micrometastatic disease.1414 Spiess PE, Horenblas S, Pagliaro LC, Biagioli MC, Crook J, Clark PE, et al. Current concepts in penile cancer. J Natl Compr Canc Netw. 2013;11:617-24 Inguinal lymph node dissection is a diagnostic and potentially curative procedure.1414 Spiess PE, Horenblas S, Pagliaro LC, Biagioli MC, Crook J, Clark PE, et al. Current concepts in penile cancer. J Natl Compr Canc Netw. 2013;11:617-24,2222 Kharadjian TB, Matin SF, Pettaway CA. Early experience of robotic-assisted inguinal lymphadenectomy: review of surgical outcomes relative to alternative approaches. Curr Urol Rep. 2014;15:412. However, due to potential complications, it is preferred to only perform this procedure in patients at a high risk for metastasis.1515 McDougal WS, Lee RJ, Efstathiou JA, Harisinghani M, Wu CL. Case records of the Massachusetts General Hospital. Case 2-2014. A 44-year-old man with a lesion on the penis. N Engl J Med. 2014;370:263-71.,2222 Kharadjian TB, Matin SF, Pettaway CA. Early experience of robotic-assisted inguinal lymphadenectomy: review of surgical outcomes relative to alternative approaches. Curr Urol Rep. 2014;15:412. Techniques such as MRI, PET scan, fine needle aspiration, and dynamic sentinel node biopsy may precede an inguinal lymph node dissection.1515 McDougal WS, Lee RJ, Efstathiou JA, Harisinghani M, Wu CL. Case records of the Massachusetts General Hospital. Case 2-2014. A 44-year-old man with a lesion on the penis. N Engl J Med. 2014;370:263-71. Minimally invasive techniques such as laparoscopic or robotic-assisted inguinal lymphadenectomy are evolving.2222 Kharadjian TB, Matin SF, Pettaway CA. Early experience of robotic-assisted inguinal lymphadenectomy: review of surgical outcomes relative to alternative approaches. Curr Urol Rep. 2014;15:412.,2323 Matin SF, Cormier JN, Ward JF, Pisters LL, Wood CG, Dinney CP, et al. Phase 1 prospective evaluation of the oncological adequacy of robotic assisted videoendoscopic inguinal lymphadenectomy in patients with penile carcinoma. BJU Int. 2013;111:1068-74. A multidisciplinary treatment team involving medical oncology, radiation oncology, urology, and psychiatry in addition to dermatology may be warranted.1515 McDougal WS, Lee RJ, Efstathiou JA, Harisinghani M, Wu CL. Case records of the Massachusetts General Hospital. Case 2-2014. A 44-year-old man with a lesion on the penis. N Engl J Med. 2014;370:263-71.,2424 Yeung LL, Brandes SB. Dynamic sentinel lymph node biopsy as the new paradigm for the management of penile cancer. Urol Oncol. 2013;31:693-6
Prognosis is good for localized disease. The most important prognostic factor is the extent of nodal metastasis.1515 McDougal WS, Lee RJ, Efstathiou JA, Harisinghani M, Wu CL. Case records of the Massachusetts General Hospital. Case 2-2014. A 44-year-old man with a lesion on the penis. N Engl J Med. 2014;370:263-71.,2121 Ficarra V, Akduman B, Bouchot O, Palou J, Tobias-Machado M. Prognostic factors in penile cancer. Urology. 2010;76:S66-73. The 5-year cancer specific survival of a primary SCC with no inguinal metastasis is 85-100%, one positive node is 79 to 89%, bilateral or multiple nodal metastasis is 17 to 60%, and metastasis to pelvic nodes is 0 to 17%.2121 Ficarra V, Akduman B, Bouchot O, Palou J, Tobias-Machado M. Prognostic factors in penile cancer. Urology. 2010;76:S66-73. Prognosis with extranodal metastasis is poor.2121 Ficarra V, Akduman B, Bouchot O, Palou J, Tobias-Machado M. Prognostic factors in penile cancer. Urology. 2010;76:S66-73.
CASE REPORT
A 60-year-old men presented for evaluation of a penile lesion present for one year. The patient denied any associated pain, bleeding, odor, discharge, or dysuria. There were no recent changes to the lesion. The patient denied history of sexually transmitted infections and reported being in a monogamous relationship with his girlfriend for 25 years. He denied any erectile dysfunction. The patient was otherwise healthy and family history was noncontributory. Physical exam was significant for a 1.5 x 1.5 cm erythematous ulcerated plaque on the inner foreskin 3 cm from the urethral tip and 1 cm from the coronal sulcus (Figure 1). Inguinal lymphadenopathy was not appreciated on palpation, however exam was limited due to the presence of bilateral inguinal hernias.
A shave biopsy was obtained and revealed invasive squamous cell carcinoma, moderately differentiated (Figure 2). The decision was made to proceed with Mohs micrographic surgery (MMS) and to refer the patient to urology for evaluation of inguinal nodes following MMS. Imaging to determine if enlarged nodes were present was not performed preoperatively.
Squamous cell carcinoma, moderately differentiated. Atypical cells extend into the deep dermis. (Hematoxylin & eosin x10)
The tumor bulk was excised, followed by one stage of MMS with excision of the borders as a horizontal layer, 2-3 mm in thickness. The tissue was mapped, frozen, cut, and stained with toluidine blue. Microscopic evaluation confirmed the tumor was completely excised with no further disease in the deep outer borders. The lesion invaded into the deep dermis with no invasion into adjacent structures. The defect was repaired in the office using linear closure (Figure 3).
The consultant urologist concluded that the patient's inguinal hernias limited nodal evaluation and recommended hernia repair prior to further assessment. The patient was seen by general surgery for evaluation, however he refused further interventions.
The patient was followed for over one year with no evidence of recurrence of the lesion and no functional concerns.
Squamous cell carcinoma of the penis is a rare diagnosis. Therapeutic decisions should be made with regard to the size and location of the tumor, as well as with consideration to the functional desires of the patient. Mohs micrographic surgery is an excellent alternative for patients with tumors of low grade and stage.
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Financial Support: None
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*
Study conducted at the Downstate and Veterans Affairs Medical Center - Brooklyn (NY), United States.
References
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1American Cancer Society. Cancer Facts and Figures 2015. Atlanta, Ga: American Cancer Society; 2015. [cited 2015 May 12]. Available from: http://www.cancer.org/cancer/penilecancer/detailedguide/penile-cancer-key-statistics
-
2Pow-Sang MR, Ferreira U, Pow-Sang JM, Nardi AC, Destefano V. Epidemiology and natural history of penile cancer. Urology. 2010;76:S2-6.
-
3Barnholtz-sloan JS, Maldonado JL, Pow-sang J, Giuliano AR, Guiliano AR. Incidence trends in primary malignant penile cancer. Urol Oncol. 2007;25:361-7.
-
4Brady KL, Mercurio MG, Brown MD. Malignant tumors of the penis. Dermatol Surg. 2013;39:527-47.
-
5Burt LM, Shrieve DC, Tward JD. Stage presentation, care patterns, and treatment outcomes for squamous cell carcinoma of the penis. Int J Radiat Oncol Biol Phys. 2014;88:94-100.
-
6Dunne EF, Nielson CM, Stone KM, Markowitz LE, Giuliano AR. Prevalence of HPV infection among men: a systematic review of the literature. J Infect Dis. 2006;194:1044-57.
-
7Lu B, Wu Y, Nielson CM, Flores R, Abrahamsen M, Papenfuss M, et al. Factors associated with acquisition and clearance of human papillomavirus infection in a cohort of US men: a prospective study. J Infect Dis. 2009;199:362-71.
-
8Giuliano AR, Lee JH, Fulp W, Villa LL, Lazcano E, Papenfuss MR, et al. Incidence and clearance of genital human papillomavirus infection in men (HIM): a cohort study. Lancet. 2011;377:932-40.
-
9Giuliano AR, Palefsky JM, Goldstone S, Moreira ED Jr, Penny ME, Aranda C, et al. Efficacy of quadrivalent HPV vaccine against HPV Infection and disease in males. N Engl J Med. 2011;364:401-11.
-
10Larke NL, Thomas SL, dos Santos Silva I, Weiss HA. Male circumcision and penile cancer: a systematic review and meta-analysis. Cancer Causes Control. 2011;22:1097-110.
-
11Morris BJ, Gray RH, Castellsague X, Bosch FX, Halperin DT, Waskett JH, et al. The Strong Protective Effect of Circumcision against Cancer of the Penis. Adv Urol. 2011;2011:812368.
-
12Reddy CR, Devendranath V, Pratap S. Carcinoma of penis--role of phimosis. Urology. 1984;24:85-8.
-
13Castellsagué X, Bosch FX, Muñoz N, Meijer CJ, Shah KV, de Sanjose S, et al. Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. N Engl J Med. 2002;346:1105-12.
-
14Spiess PE, Horenblas S, Pagliaro LC, Biagioli MC, Crook J, Clark PE, et al. Current concepts in penile cancer. J Natl Compr Canc Netw. 2013;11:617-24
-
15McDougal WS, Lee RJ, Efstathiou JA, Harisinghani M, Wu CL. Case records of the Massachusetts General Hospital. Case 2-2014. A 44-year-old man with a lesion on the penis. N Engl J Med. 2014;370:263-71.
-
16Chaux A, Cubilla AL. Advances in the pathology of penile carcinomas. Hum Pathol. 2012;43:771-89.
-
17Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer; 2010.
-
18Shindel AW, Mann MW, Lev RY, Sengelmann R, Petersen J, Hruza GJ, et al. Mohs micrographic surgery for penile cancer: management and long-term followup. J Urol. 2007;178:1980-5.
-
19Wells MJ, Taylor RS. Mohs micrographic surgery for penoscrotal malignancy. Urol Clin North Am. 2010;37:403-9.
-
20Kieffer JM, Djajadiningrat RS, van Muilekom EA, Graafland NM, Horenblas S, Aaronson NK. Quality of life in patients treated for penile cancer. J Urol. 2014;192:1105-10.
-
21Ficarra V, Akduman B, Bouchot O, Palou J, Tobias-Machado M. Prognostic factors in penile cancer. Urology. 2010;76:S66-73.
-
22Kharadjian TB, Matin SF, Pettaway CA. Early experience of robotic-assisted inguinal lymphadenectomy: review of surgical outcomes relative to alternative approaches. Curr Urol Rep. 2014;15:412.
-
23Matin SF, Cormier JN, Ward JF, Pisters LL, Wood CG, Dinney CP, et al. Phase 1 prospective evaluation of the oncological adequacy of robotic assisted videoendoscopic inguinal lymphadenectomy in patients with penile carcinoma. BJU Int. 2013;111:1068-74.
-
24Yeung LL, Brandes SB. Dynamic sentinel lymph node biopsy as the new paradigm for the management of penile cancer. Urol Oncol. 2013;31:693-6
Publication Dates
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Publication in this collection
Jan-Feb 2017
History
-
Received
04 Aug 2015 -
Accepted
28 Oct 2015