Penile Cancer
Overview
Penile cancer is an uncommon cancer that develops in the skin and tissues of the penis. Most cases start on the glans (head of the penis) or foreskin (in men who are not circumcised), and less commonly on the shaft.
Types
The most common type is squamous cell carcinoma, which begins in the skin cells.
Why early assessment matters
Penile cancer is often very treatable when found early. Early diagnosis increases the chance of penile-preserving treatment and reduces the risk of spread to the lymph nodes in the groin.
Risk factors
Not everyone has a clear cause, but factors that can increase risk include:
Persistent HPV infection (some strains)
Phimosis (tight foreskin) and chronic inflammation
Smoking
Increasing age
Poor genital hygiene (often linked with phimosis)
A reassuring note
Many penile skin changes are not cancer (e.g., infections, inflammation, benign skin conditions). The key message is: if it persists, get it checked.
When to book an appointment: any penile lump, ulcer, or skin change lasting more than 2–3 weeks.
Symptoms & When to Seek Help
Possible symptoms
Penile cancer may appear as:
A lump, growth, or thickened area (often on the glans or under the foreskin)
A sore/ulcer that doesn’t heal
Bleeding or discharge, sometimes with an odour
A persistent red patch, velvety area, or wart-like lesion
Pain or tenderness (not always present)
Difficulty retracting the foreskin (new or worsening phimosis)
Groin symptoms (important)
Cancer can spread to groin lymph nodes. Seek prompt review if you notice:
A new lump/swelling in the groin
Persistent groin discomfort or swelling
When is it urgent?
Please seek medical assessment promptly if:
A lesion is growing, bleeding, or ulcerated
Symptoms persist beyond 2–3 weeks
You have a groin lump
What not to do
Don’t repeatedly self-treat with creams for weeks without a diagnosis.
Don’t assume it’s an infection if it doesn’t improve quickly.
How Penile Cancer Is Diagnosed
Step 1: Medical history + examination
Your urologist will:
Ask about symptoms, duration, irritation/inflammation, HPV history, smoking, and urinary symptoms
Examine the penis and check both groins for lymph nodes
Step 2: Biopsy (the key test)
A biopsy means taking a small sample to check under the microscope. It confirms:
Whether it is cancer
The type of cells
How aggressive it looks (grade)
Biopsies are usually done with local anaesthetic or as a short day procedure.
Step 3: Imaging
Imaging helps determine the extent (stage) and whether lymph nodes are involved. Depending on your situation, this may include:
Ultrasound of the penis or groin
CT or MRI scans
What results mean
Your team uses clinical assessment + biopsy + imaging to decide:
Whether you’re suitable for penile-preserving surgery
Whether the groin lymph nodes need further assessment or surgery
The most appropriate method to reconstruct the genitalia to preserve function
Staging & Treatment Planning
What “stage” means
Staging describes:
How deep the cancer has grown into the penis
Whether it involves nearby structures
Whether it has spread to groin lymph nodes or elsewhere
Why lymph nodes matter
The groin lymph nodes are the most common first place penile cancer spreads. Even if nodes feel normal, some cancers have a higher risk of microscopic spread—this influences whether your team recommends node sampling or surgery.
How treatment is chosen
Your plan depends on:
Tumour size and depth
Location (glans, foreskin, shaft)
Tumour grade (how aggressive it looks)
Lymph node risk
Your goals (function, appearance) and overall health
Multidisciplinary care
Penile cancer is often managed through a specialist team to ensure the best balance between cure and preservation.
Penile-Preserving Surgery Options
These operations aim to remove the cancer while preserving as much normal tissue and function as possible, when it is safe.
Common penile-preserving operations
Circumcision
Used when the lesion is on/under the foreskin
May be combined with biopsy or further excision depending on results
Wide local excision
The tumour is removed with a margin of healthy tissue
The area may be closed directly or reconstructed
Glans resurfacing
The surface layer of the glans is removed and replaced with a skin graft
Used for very superficial disease on the glans
Reconstructed with split thickness skin graft
Glansectomy (removal of the glans)
For deeper or more extensive glans tumours
Reconstruction is often performed to improve appearance and function
May be reconstructed with split skin graft
What to expect after penile-preserving surgery
Usually a day procedure or short hospital stay
Wound care and temporary activity restrictions
Some swelling and sensitivity are common early on
Often may require a temporary urinary catheter and special dressings management
Your surgeon will advise when sex can be resumed (often several weeks)
Key risks
Bleeding, infection, wound healing issues
Change in sensation, scarring, cosmetic change
Recurrence risk: requires reliable follow-up
When penile-preserving surgery may not be best
If the tumour is large, deeply invasive, or involves the shaft extensively, your team may recommend more definitive surgery for cure.
Groin Lymph Node Surgery
Why groin nodes are treated
Penile cancer can spread first to the inguinal (groin) lymph nodes. Treating involved nodes can improve cure rates, and checking nodes early can guide the safest next step.
How nodes are assessed
Depending on your risk and findings, your team may recommend:
Surveillance (close monitoring) in selected low-risk cases
Sentinel lymph node biopsy (DSNB) in selected patients
Inguinal lymph node dissection (ILND) if nodes are involved or risk is high
Sentinel lymph node biopsy
What it is
A sentinel lymph node biopsy is a way of checking the smallest possible number of lymph nodes in the groin to see if cancer cells have started to spread. The “sentinel” nodes are the first nodes that lymph fluid from the penis drains into—so they are the most likely place early spread would show up.
Who might need it
You may be offered this test when:
There is no obvious enlarged lymph node on examination, but
Based on the tumour features, there is still a meaningful risk of microscopic spread.
How it’s done
In most centres this is done using a tracer technique:
A small amount of dye and/or a weak radioactive tracer is used to map which groin nodes drain the penis.
The surgeon removes those mapped sentinel nodes through small incisions.
The nodes are sent to the lab to look for cancer cells.
What the results mean
Negative (no cancer found): suggests the cancer has not spread to the groin nodes, so you may avoid larger node surgery (with ongoing follow-up).
Positive (cancer found): usually means you’ll be recommended further groin treatment—often an inguinal lymph node dissection and sometimes additional treatments depending on extent.
Pros and cons
Pros: checks nodes accurately while removing fewer nodes than a full dissection, which can mean less swelling and fewer wound problems for many patients.
Cons: it’s a specialist procedure and not available everywhere; like all tests it can have a false-negative risk, so follow-up remains important.
Inguinal lymph node dissection (ILND)
If nodes are involved (or the risk is high), surgery to remove more lymph nodes in the groin may be recommended.
Key risks: wound infection/delayed healing, fluid collections (seroma/lymphocele), and lymphoedema (leg/genital swelling).