Penile skin cancer is rare, accounting for less than one percent of all cancers diagnosed in males in regions like the United States and Europe. This malignancy originates in the skin and mucosal surfaces of the organ. It most commonly appears on the glans (head) and the foreskin in uncircumcised individuals. The outcome is strongly influenced by the stage at which the cancer is identified, making early detection crucial for successful treatment.
Types of Penile Skin Cancer
The vast majority of penile cancers (over 95%) are classified as Squamous Cell Carcinoma (SCC), which arises from the flat, scale-like epithelial cells covering the surface. SCC includes pre-invasive conditions confined to the top layer of the skin. One early form is Carcinoma in Situ (CIS), also known as Penile Intraepithelial Neoplasia (PeIN), which has not yet spread beneath the surface layer. Bowen’s disease refers to CIS on the shaft, while Erythroplasia of Queyrat describes CIS on the glans or foreskin. Identifying these pre-cancers is important because localized, non-invasive treatments can often achieve a cure.
Other forms of skin cancer affect the penis much less frequently. Basal Cell Carcinoma (BCC) is a slow-growing cancer originating in the deepest layer of the epithelium, making up less than two percent of cases. Melanoma, a more aggressive form developing from pigment-producing cells, is also extremely uncommon, accounting for less than one percent of cases.
Visual Symptoms and Warning Signs
The physical appearance of penile skin cancer often starts with subtle changes that may be mistaken for minor irritation or infection. A primary warning sign is a persistent sore, ulcer, or lesion that does not heal after two to four weeks. These lesions may be painful or painless and can bleed easily upon contact.
Patients may notice changes in skin texture, such as an area becoming thickened, hardened, or developing a rough, crusty surface, often occurring on the glans or under the foreskin. The development of a firm lump or a wart-like growth on the shaft or glans also warrants medical evaluation. Alterations in skin color are common, manifesting as reddish patches that look like a persistent rash, or less commonly, flat, bluish-brown growths.
For uncircumcised individuals, a persistent, foul-smelling discharge collecting under the foreskin, often accompanied by swelling or difficulty retracting the foreskin (phimosis), requires immediate investigation. While benign conditions can cause these symptoms, any new change that does not resolve quickly must be assessed by a healthcare professional.
Specific Risk Factors and Prevention
The development of penile skin cancer is primarily associated with chronic inflammation and infection, rather than sun exposure. A major contributing factor is the Human Papillomavirus (HPV) infection, particularly high-risk types like HPV-16, which is detected in a significant percentage of SCC cases.
Chronic inflammatory conditions also increase risk, including Lichen Sclerosus and Phimosis, where the foreskin is too tight to be retracted. Phimosis is concerning because it allows smegma (dead skin cells and oils) to build up, creating chronic irritation that promotes cellular changes. Other risk factors include smoking and immunosuppression, such as that caused by HIV infection.
Circumcision offers a protective effect by eliminating the foreskin, preventing phimosis, and making genital hygiene easier. Prevention strategies involve the HPV vaccine, maintaining good personal hygiene (especially for uncircumcised men), avoiding tobacco products, and managing chronic inflammatory conditions.
Diagnosis and Treatment Options
Diagnosis begins with a thorough physical examination, where the provider inspects the lesion and checks the groin lymph nodes for swelling. If a suspicious area is identified, a biopsy is performed to remove a small tissue sample for laboratory analysis. This step is the only definitive way to confirm the presence and type of cancer cells. Once confirmed, imaging tests like CT scans or MRIs may be used for staging, determining the extent of the disease and whether it has spread. Treatment planning is individualized, focusing on achieving a cure while preserving the appearance and function of the penis whenever possible.
For very early-stage cancers, such as Carcinoma in Situ, localized treatments are often effective, including topical chemotherapy creams or laser ablation to destroy cancerous cells. Invasive cancers typically require surgical intervention. This ranges from wide local excision (removing the tumor with a margin of healthy tissue) to Mohs surgery, a layer-by-layer technique that maximizes tissue preservation.
For advanced tumors, a partial or total penectomy may be necessary to ensure complete removal, though surgeons prioritize the most conservative approach. Other modalities include radiation therapy, which uses high-energy rays to kill cancer cells, and chemotherapy, used to shrink tumors before surgery or treat cases where the cancer has spread to distant sites.