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KeratinocyteMucosalICD-10 C60

Penile squamous cell carcinoma

Penile SCC; carcinoma of penis; SCC of penis

Penile SCC is a rare UK cancer (~ 700 new diagnoses per year) but with substantial morbidity and mortality if diagnosis is delayed. HPV-driven disease accounts for approximately 30–50%, arising from erythroplasia of Queyrat and bowenoid papulosis in younger men; HPV-independent disease arises in the context of lichen sclerosus in older men. Phimosis, smoking, poor genital hygiene, HIV and immunosuppression are recognised risk factors. UK practice follows AJCC 8 / EAU staging and BAUS / EAU guidance, with a strong move toward penile-preserving surgery.

CurrentLast reviewed 15 May 2026

Clinical features

  • Most lesions develop on the glans (~ 50%) or prepuce (~ 20%); shaft and coronal sulcus less commonly.
  • Persistent papule, plaque, ulcer or warty lesion; bleeding, discharge, foul odour.
  • Phimosis often coexists and obscures early disease.
  • Inguinal lymphadenopathy at presentation in 30–60% — palpable nodes may be reactive or metastatic; ultrasound and FNA / biopsy required.
  • Risk factors — phimosis, lichen sclerosus, HPV, smoking, poor hygiene, HIV.

Precursor lesions

  • Erythroplasia of Queyrat — penile SCC in situ on glans / prepuce; HPV-driven.
  • Bowenoid papulosis — multiple small HPV-driven papules; lower invasive risk.
  • Bowen disease of the penis — SCC in situ on the shaft.
  • Lichen sclerosus — chronic inflammatory dermatosis; long-standing balanitis xerotica obliterans confers ~ 4–8% lifetime SCC risk.
  • Active surveillance and treatment of precursors reduces invasive cancer incidence.

Staging (AJCC 8 / EAU)

  • T category — Ta (warty / verrucous in situ), Tis (carcinoma in situ), T1a (subepithelial connective tissue without LVI / PNI, well/mod differentiated), T1b (with LVI, PNI or poor differentiation), T2 (corpus spongiosum or urethra), T3 (corpus cavernosum), T4 (adjacent structures).
  • N category — N1 single inguinal mobile node; N2 multiple unilateral or bilateral inguinal nodes; N3 fixed inguinal or pelvic nodes.
  • M — M0 / M1.
  • Workup — clinical examination, examination under anaesthetic, biopsy, ultrasound and FNA of inguinal nodes, CT NCAP, MRI pelvis for staging.

Management

  • Carcinoma in situ / Ta — topical 5-fluorouracil 5% or topical imiquimod 5% for 4–6 weeks (with circumcision for foreskin disease); CO₂ laser ablation; glansectomy or partial glans resurfacing for unresponsive disease.
  • T1a localised — circumcision (preputial disease), wide local excision, glansectomy, or partial penectomy depending on site and extent. Penile-preserving surgery preferred where margins achievable.
  • T1b / T2 / T3 — partial penectomy with 5–10 mm margin OR penile-preserving glansectomy with reconstruction if achievable; consider neoadjuvant chemotherapy for downsizing.
  • Nodal disease — clinically node-negative (cN0) patients with ≥ T1b or high-grade disease undergo invasive nodal staging by dynamic sentinel lymph node biopsy (or modified inguinal lymphadenectomy); radical inguinal lymphadenectomy is reserved for proven or clinically positive nodes (EAU / BAUS); neoadjuvant chemotherapy (cisplatin-based, e.g. TIP (paclitaxel + ifosfamide + cisplatin)) for bulky / fixed nodes.
  • Advanced / metastatic — cisplatin-based chemotherapy ± concurrent radiotherapy; emerging role for cemiplimab (TA802 in cSCC but penile SCC trial enrolment) and pembrolizumab for PD-L1+ disease.
  • Sexual function and psychological support throughout treatment is essential.

Prevention

  • Neonatal / adult circumcision substantially reduces lifetime penile SCC risk in populations with high baseline incidence.
  • HPV vaccination (9-valent / Gardasil 9) is part of the UK adolescent vaccination programme; expanding evidence of penile cancer reduction.
  • Smoking cessation.
  • Active treatment of lichen sclerosus with potent topical steroids reduces inflammatory burden and possibly SCC risk.
  • Active surveillance of recognised precursor lesions.

References

  1. Hakenberg OW et al. EAU guidelines on penile cancer. 2024 update.
  2. BAUS — Penile cancer guidelines.
  3. NICE CSG2. Improving outcomes in urological cancers. London: NICE; 2002.
  4. Amin MB, Edge SB, Greene FL et al., eds. AJCC Cancer Staging Manual. 8th ed. New York: Springer; 2017.

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