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Penile Cancer

by Viraj A. Master, MD, PhD

Cancers of the penis are usually types of skin cancers. Skin cancer can occur anywhere on the penis, but it most commonly occurs at the glans penis (the cone-shaped end of the penis), especially its base. Cancers affecting the skin of the penis, uncommon in the United States, are even rarer in men who have been circumcised.

Causes

The cause of cancer of the penis may be long-standing irritation, usually under the foreskin. Infection with human papillomavirus and being uncircumcised increase the risk. Squamous cell carcinoma (see Squamous Cell Carcinoma) occurs most commonly. Early forms of cancer that are less common include Bowen disease (see Skin Cancers:Bowen disease (intraepidermal squamous cell carcinoma)), Extramammary Paget disease (see Paget Disease of the Nipple) and erythroplasia of Queyrat.

Symptoms

Cancer usually first appears as a painless, reddened area, often with sores, but it can also be a hardened area or look like a wart. Cancers, unlike many other growths, do not heal for weeks. Erythroplasia of Queyrat and causes a discrete, reddish, velvety or crusted area on the penis, usually on the glans penis or the inner foreskin. Bowen disease appears the same but affects the shaft. Bowenoid papulosis appears as bumps that are usually smaller, on the shaft of the penis. Lymph nodes in the groin may become enlarged because the cancer has spread to them or because they are infected and inflamed.

Diagnosis

To diagnose cancer of the penis, doctors remove a tissue sample for examination under a microscope (biopsy). Sometimes computed tomography or magnetic resonance imaging is done to determine whether the cancer has spread into other tissues outside the penis. Enlarged and inflamed lymph nodes may be biopsied.

Treatment

To treat early or small cancers, doctors prescribe a cream containing fluorouracil or imiquimod or remove the cancer and some normal surrounding tissue with a laser or during surgery. For other cancers, doctors surgically remove the cancer, sparing as much of the penis as possible. Usually, men who undergo this type of surgery are able to use the remaining penile tissue for urination and sexual function. If cancer involves larger areas, the penis needs more extensive surgery.

In most men, cancers are small and have not spread. These men survive for many years after treatment. Most men with cancer that has spread beyond the groin lymph nodes die within 5 years.

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