Diagnostic Approaches in Penile Cancer: From Clinical Examination to Biopsy

Summary Penile cancer is heterogenous in its clinical presentation. Penile cancer may present as a thickened red lesion, an erosive ulcer, a hyperkeratotic/ scabbing lesion, a warty growth, a palpable nodule or a large erosive or fungating mass. It may not be visible if there is phimosis or if it is originating within the urethra. Acetic acid can assist diagnosis of PeIN. Imaging of the primary tumour with MRI or ultrasound scan is not necessary in most cases but may help determine the extent of invasion and potential surgery required. In cN0 patients, surgical staging of the inguinal nodes is strongly recommended (if G3 and / or T1b or higher) and is more accurate than staging MRI or CT scans. A biopsy of a penile lesion should be taken if there is any uncertainty over the clinical diagnosis. Address patients’ psychological needs following penile cancer diagnosis and offer a multidisciplinary and holistic approach to consultations.