Penile cancer is a disease in which malignant (cancerous) cells form in the tissues of the penis. The penis is made up of several types of tissue, including skin, nerves, smooth muscle, and blood vessels. Cancer can develop in any of these, but the vast majority arise from the skin.

Over 95% of all penile cancers are squamous cell carcinomas. This means they develop from the thin, flat, skin-like cells (squamous cells) that cover the surface of the penis. This type of cancer usually develops very slowly. Most often, it begins on or under the foreskin in uncircumcised men, or on the glans (the head of the penis).

Other, much rarer types of penile cancer can include:

• Melanoma: A type of skin cancer that begins in the pigment-producing melanocytes.
• Basal Cell Carcinoma: Another type of skin cancer that is much less aggressive than squamous cell carcinoma or melanoma.
• Sarcoma: A cancer that develops from the smooth muscle or blood vessels within the penis.

In my experience, many patients delay seeking help for penile changes due to embarrassment. Unfortunately, this often leads to a more advanced stage at diagnosis.

The fundamental cause of penile cancer is DNA damage to skin cells on the penis. This damage leads to mutations that cause the cells to lose their normal growth controls, allowing them to divide uncontrollably and form a tumor. The factors leading to this DNA damage are often related to chronic inflammation and persistent infection with a specific virus.

• Human Papillomavirus (HPV): A chronic infection with certain high-risk strains of HPV is considered a primary cause of many penile cancers. This is the same virus that is well-known for causing cervical cancer in women, and other anogenital and throat cancers. The most common cancer-causing strains are HPV-16 and HPV-18. In most people, the immune system clears an HPV infection on its own. However, in some individuals, the infection can persist for many years, and the viral DNA can integrate into the host’s cells, disrupting the normal mechanisms that control cell growth and leading to the development of cancer.
• Chronic Inflammation: Long-term irritation and inflammation of the penile skin can also promote cancer development. This is most often seen in uncircumcised men who have phimosis (a tight foreskin that cannot be retracted) or who have poor hygiene. The buildup of secretions, oils, and bacteria under the foreskin (a substance called smegma) can cause chronic inflammation, which over time can lead to cancerous changes in the skin.

In my experience, lack of circumcision in childhood and smoking both increase the risk significantly, especially when combined with high-risk HPV exposure.

A person develops penile cancer due to a combination of risk factors that either promote chronic inflammation or increase the likelihood of a persistent HPV infection. The condition is not contagious, although the HPV virus that can cause it is.

The most significant and well-established risk factors include:

• Not Being Circumcised: This is the single greatest risk factor for developing penile cancer. Circumcision, especially when performed in infancy, almost eliminates the risk. This is because removing the foreskin prevents the buildup of smegma and the development of phimosis, thereby reducing chronic inflammation.
• Human Papillomavirus (HPV) Infection: Having an infection with a high-risk HPV strain significantly increases the risk.
• Phimosis: An inability to retract the foreskin, leading to poor hygiene and chronic inflammation.
• Age: The risk of penile cancer increases with age. It is rare in men under 50 and is most commonly diagnosed in men over the age of 60.
• Smoking: The carcinogens in tobacco can damage DNA throughout the body, and smoking is a known risk factor for developing penile cancer.
• A Weakened Immune System: Individuals with a compromised immune system, such as those with HIV/AIDS, are at a higher risk.
• Psoriasis Treatment: A specific, older treatment for psoriasis called PUVA therapy (psoralen plus ultraviolet A light) has been linked to an increased risk.

In my experience, men acquire risk primarily through persistent HPV infection, especially if they are uncircumcised and practice poor hygiene.

The key to a successful outcome is early detection. This means being aware of the signs and symptoms and seeing a doctor for any persistent changes to the penis.

The most common sign of penile cancer is a skin change. This can include:

• A new growth or lump on the penis, most often on the glans or foreskin.
• An ulcer or sore that does not heal within a few weeks.
• A change in skin color, such as a reddish, velvety rash or a flat, grayish patch.
• Thickening of penis skin.
• Persistent discharge or bleeding from under the foreskin.
• A foul-smelling odor from under the foreskin.
• Swelling at the end of the penis.

Signs of More Advanced Disease

If the cancer spreads, the first place it typically goes is to the lymph nodes in the groin. A lump or mass in the groin is a critical sign that the cancer may have spread and requires immediate medical attention.

Clinically, any non-healing lesion on the penis lasting more than a few weeks raises concern especially if accompanied by itching, pain, or skin thickening.

If you have a suspicious sore, lump, or other change on your penis, your doctor will likely refer you to a urologist, a specialist in urinary and male reproductive system disorders. The diagnostic process is straightforward.

1. Medical History and Physical Examination: The doctor will ask about your symptoms and risk factors and will perform a careful examination of the penis and groin area, feeling for any lumps or swollen lymph nodes.
2. Biopsy: A biopsy is the only way to make a definitive diagnosis of cancer. This is a simple procedure, usually performed in the doctor’s office under local anesthesia. The doctor will remove a small sample of the abnormal tissue.
3. Pathology: The tissue sample is sent to a pathologist, who examines it under a microscope to see if cancer cells are present. If cancer is found, the pathologist will also determine its type (e.g., squamous cell carcinoma) and its grade (how aggressive it looks).
4. Staging: If the biopsy confirms cancer, a series of imaging tests will be performed to determine the stage of the cancer, that is, how large it is and whether it has spread. This may include a CT scan or MRI of the pelvis and abdomen, and sometimes a PET scan.

In my experience, early diagnosis often hinges on patient education and reduced stigma. Delays are common due to shame or misdiagnosis as infections.

Treatment of penile cancer depends on the stage of the cancer. Treatment is managed by a multidisciplinary team that may include a urologist, a radiation oncologist, and a medical oncologist.

The primary goals of treatment are to cure the cancer while also preserving as much of the penis and its function (both urinary and sexual) as possible.

Treatment for Precancerous Lesions (Carcinoma in Situ)

If the abnormality is confined to the very top layer of the skin, treatments can be very minimal.

• Topical Therapies: Chemotherapy creams (like 5-fluorouracil) or immunotherapy creams (like imiquimod).
• Laser Ablation: Using a focused laser beam to destroy the abnormal cells.
• Circumcision: If the lesion is only on the foreskin, removing the foreskin can be a curative treatment.

Treatment for Early-Stage, Localized Cancer

For small cancers that have not invaded deeply, organ-sparing techniques are the standard of care.

• Wide Local Excision: The surgeon removes the tumor along with a small margin of healthy tissue around it.
• Mohs Surgery: A specialized technique where the surgeon removes the tumor one thin layer at a time, checking each layer under a microscope until all the cancer is gone. This preserves the maximum amount of healthy tissue.
• Radiation Therapy: High-energy beams can be used to destroy the tumor. This can be delivered from an external machine or via internal radiation (brachytherapy).

Treatment for More Advanced Cancer

If the tumor is larger or has grown deeper into the tissues of the penis, more extensive surgery is required.

• Partial Penectomy: The surgical removal of the end of the penis, including the tumor.
• Total Penectomy: The surgical removal of the entire penis.
• In either case, the surgeon will create a new opening for urination (a perineal urethrostomy).

If the cancer has spread to the lymph nodes in the groin, a lymph node dissection (surgery to remove the lymph nodes) will be necessary. Chemotherapy and radiation therapy are also used to treat advanced disease that has spread.

I tailor treatment based on stage from topical chemotherapy for early lesions to partial or total penectomy in advanced cases, sometimes with lymph node dissection.

A diagnosis of penile cancer can be deeply distressing, but it is important to focus on the facts. It is a rare cancer, and most importantly, it is highly curable when detected in its early stages. The keys to a successful outcome are prevention and early detection. The risk can be dramatically reduced through measures like infant circumcision and the HPV vaccine. For all men, the most critical step is to overcome any embarrassment or fear and to seek a prompt evaluation from a doctor for any new lump, sore, or skin change on the penis that does not heal within a few weeks. Clinically, I’ve seen that timely treatment not only improves survival but also preserves urinary and sexual function in many early-stage cases.

American Cancer Society. (2024). Penile Cancer. Retrieved from https://www.cancer.org/cancer/penile-cancer.html

National Cancer Institute (NCI). (2023). Penile Cancer Treatment (PDQ®)–Patient Version. Retrieved from https://www.cancer.gov/types/penile/patient/penile-treatment-pdq

The Urology Care Foundation. (n.d.). Penile Cancer. Retrieved from https://www.urologyhealth.org/urology-a-z/p/penile-cancer