Typically a painless, red, raised lesion.
Other presenting features may include phimosis, discharge, bleeding or pain.
Buck’s fascia can act as a natural barrier to prevention of invasion to the vascular corpora.
Natural history if progression of the primary lesion and destruction of the penis locally, with lymphatic drainage in a predictable step-wise pattern to bilateral superficial inguinal nodes, to the deep inguinal nodes below fascia lata, then to pelvic nodes.
History
- Duration / timeframe (often delayed presentation)
- Medical history / medications / immunosuppression
- Social and sexual history
- Previous surgery
- LUTS
Examination
Primary lesion:
- Size, location, multiplicity
- Full retraction of foreskin if able
- Mobility of lesion
- Relationship to urethra, glans
- Length of penis and body habitus / suitability for organ preserving
Nodes:
- Clinical assessment of the nodes is imperative
- Inguinal lymph node exam in frog leg position – number palpable if any, mobile/fixed, unilateral or bilateral
General examination / frailty
Investigations:
- Biopsy of the primary lesion (incisional vs excisional)
- CT chest/abdo/pelvis – looking at inguinal nodes & pelvic nodes specifically +/- mets
- USS groin +/- FNA
- PET/CT role emerging – likely useful for distant disease, sensitivity > 80 % for palpable nodes
- USS or MRI of the penis may be used to establish whether corporal invasion is present if considering organ-preserving surgery, or MRI possibly if further anatomical clarity is needed, e.g. phimosis