What question did this study set out to answer?

This case aims to illustrate the association between chronic balanoposthitis and the development of penile squamous cell carcinoma in a diabetic man.

June 17, 2026Open Access

Keratinizing Penile Squamous Cell Carcinoma Arising from Chronic Balanoposthitis in an Uncircumcised Diabetic Man: A Case Report from a Rural Tertiary Hospital in Uganda

Key Points

This case aims to illustrate the association between chronic balanoposthitis and the development of penile squamous cell carcinoma in a diabetic man.
Case presentation of a 75-year-old uncircumcised man with penile mass and chronic balanoposthitis.
Clinical examination and histopathological analysis of the tumor post-partial penectomy.
Lack of molecular screening due to resource constraints in the clinical setting.
Confirmed diagnosis of well-differentiated keratinizing squamous cell carcinoma (pT2 cN0 M0) from biopsy.
Patient underwent successful surgery with an uneventful recovery.
Emphasized need for early intervention and molecular diagnostics in resource-limited environments.

Abstract

Background: Penile squamous cell carcinoma (SCC) primarily develops through two distinct etiopathogenic routes: human papillomavirus (HPV)-mediated and non-viral, chronic inflammation-driven pathways. In low-resource settings, long-standing phimosis and recurrent balanoposthitis present significant public health challenges that accelerate tissue transformation. Case Presentation: We report a case of an uncircumcised 75-year-old African man presenting to a tertiary facility in Southwestern Uganda with a 2-year history of a progressive, painful, exophytic penile mass associated with chronic balanoposthitis and a 7-year history of Type 2 Diabetes Mellitus. Clinical examination revealed a 4.0 cm × 5.0 cm ulcerated, necrotic tumor involving the glans penis and distal shaft, along with bilateral 1.5 cm palpable inguinal lymph nodes. Due to resource constraints at our center, molecular screening (p16 immunohistochemistry and HPV DNA PCR) and staging node biopsies were unavailable. Histopathological examination of the partial penectomy specimen confirmed a well-differentiated, keratinizing squamous cell carcinoma (pT2 cN0 M0). The patient experienced an uneventful postoperative recovery and was transitioned to a structured clinical surveillance program. Discussion: This case highlights the role of chronic balanoposthitis, diabetes mellitus, and poor foreskin ventilation in promoting a sustained inflammatory microenvironment that may predispose to malignant transformation of penile epithelium. It underscores the diagnostic challenge posed by inflammatory penile lesions that mimic benign disease and the consequences of delayed medical evaluation. Conclusion: This case provides a descriptive illustration of penile carcinoma emerging in a background of chronic inflammation, highlighting the clinical realities of managing advanced disease in a resource-limited environment. It underscores the critical need for localized screening, early surgical intervention for phimosis, and improved access to molecular diagnostics in sub-Saharan Africa. Keywords: penile squamous cell carcinoma, chronic balanoposthitis, penile cancer, diabetes mellitus, chronic inflammation

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