Carcinoma of the penis is seen in uncircumcised men and is extremely rare in those who have been circumcised. It accounts for less than 1 per cent of all malignancies, occurring most frequently in the 50 to 60-year-old age group, and has an incidence in the United States of 1 to 2 cases per 100000 per annum. It is possibly related to previous infection with the human papilloma virus and is unusual in men who are able to retract and clean the foreskin.

Erythroplasia of Queyrat (or Bowen's disease) was first described in 1911. It is a precancerous condition (carcinoma in situ) of the skin of the glans of the penis which responds to local irradiation or 5-fluorouracil cream.

Carcinoma of the penis is a squamous cell carcinoma with varying frequency of mitosis. It arises on the glans and spread locally, invading the corpora spongiosum and then spreading through the venous system, although initially it tends to spread through the lymphatics involving the inguinal and pelvic lymph nodes. The most common classification is that of Jackson (Table 1) 474.

Classically carcinoma of the penis appears in elderly men with poor hygiene of the uncircumcised penis (Fig. 1) 1612. There is usually associated infection that causes enlargement of the localized inguinal lymph nodes and it is important not to assume that these are infiltrated with tumour, as they often resolve following surgery to the penis.

Any suspicious lesion on the penis should be examined by biopsy. Occasionally stage I disease may be cured by circumcision. A local tumour on the glans of the penis can be treated locally with radiotherapy, often using radioactive iridium. In the case of stage II disease, radiotherapy may be tried although local amputation is often necessary, while in stage III disease, radical amputation of the penis is necessary with reconstruction of the urethra with a scrotal flap. Although in stage IV disease, preliminary radiotherapy may be attempted, this often fails. Block dissection of the inguinal nodes may be worthwhile, although once the inguinal nodes are involved the outlook is poor.

This most frequently presents itself as a white patch on the prepuce or glans occurring in both circumcised and uncircumcised men. Histologically it is similar to lichen sclerosis et atrophicus. Meatal stenosis is treated by dilatation, meatotomy, or topical steroids. Malignant change occurs rarely.

Jackson SM. The treatment of carcinoma of the penis. Br J Surg 1966; 53: 33.

Schellhammer PF, Jordan GH, Schlossberg SM. Tumors of the penis. In: Walsh PC, Retik AB, Stamey TA, Vaughan ED, eds. Campbell's Urology. 6th edn. Philadelphia: WB Saunders Co, 1992: 1264–98.