Synopsis
Recognise persistent penile lesions, obtain histology before destructive treatment, preserve organ and function where oncologically safe and stage inguinal nodes actively because nodal burden determines prognosis.
- Persistent surface lesion is a pivotal clue in Penile cancer: Ulcer, plaque, nodule, warty growth, colour change or induration is suspicious when persistent or progressive.
- Immediate priority in unstable Penile cancer: Stabilise bleeding and infection, provide analgesia and urinary drainage by an oncologically safe route with urology, and involve the specialist penile cancer centre urgently rather than performing unplanned local excision.
- Clinical examination and photography with consent is used early to map lesion site, size, surface, shaft involvement and both groins before biopsy. Record foreskin, glans, corporal and urethral features and node size or mobility; sensitive consent and chaperoning support accurate follow-up.
Key red flags
A painless ulcer, nodule, induration, warty growth or bleeding lesion persists on glans, prepuce or shaft.
Major bleeding, sepsis or urinary obstruction from advanced disease requires acute stabilisation and specialist transfer.
Investigation priorities
Map lesion site, size, surface, shaft involvement and both groins before biopsy.
Management branches
A persistent penile lesion is suspicious for intraepithelial or invasive cancer.
- Examine and document the entire penis and both groins, address phimosis enough to visualise the lesion and make an urgent specialist referral.
- Obtain representative incisional, punch or excisional biopsy with adequate depth before topical, laser or major surgery.
Key medicines
Imiquimod 5% cream for penile intraepithelial neoplasiaApply a thin layer to the affected area three times weekly at night, leave for about 6–10 hours and wash off, commonly for up to 12 weeks under specialist supervision with response checks.
Topical fluorouracil for penile intraepithelial neoplasiaA specialist regimen commonly applies fluorouracil 5% cream thinly once or twice daily for 4–6 weeks, with exact frequency adjusted to local reaction and product guidance.