Neonatal circumcision and invasive squamous cell carcinoma of the penis: a report of 3 cases and a review of the literature

A 55-year-old man presented with a nonhealing lesion on his glans penis that had not responded to steroid creams. He was circumcised as an infant but had a history of penile warts 25 years earlier. He was a former smoker and denied any high-risk sexual behaviour. There was no history of trauma to the penis, but he had attributed the lesion to friction induced by bike shorts. On examination, an erythematous lesion measuring 1.5 cm 2.4 cm was present on the ventral surface of the glans near the urethral meatus. The depth of the lesion was 2-3 mm. Biopsy, performed 18 months after the onset of the symptoms, revealed a moderately differentiated squamous cell carcinoma. In situ hybridization did not detect HPV DNA in the biopsy specimen. There was no clinical evidence of inguinofemoral lymphadenopathy (T1N0). The patient was treated with interstitial brachytherapy in April 2002. Abdomino-pelvic CT scan in May 2002 showed a 3.0 cm 1.3 cm lymph node in the right inguinal region. The patient underwent bilateral superficial inguinal dissection in June 2002, but all the lymph nodes were negative for malignancy. Four years after the procedure, he was disease-free with good cosmesis and sexual function.