Penile carcinoma: a challenge for the developing world

Although rare in developed countries, carcinoma of the penis is an important problem in the developing world. Circumcision done in childhood offers the greatest protection against this disease. Poor penile hygiene and phimosis are strong risk factors for development of penile carcinoma. Early disease can be treated by conventional resection of the penis, or in selected patients by organ preserving techniques including Mohs micrographic surgery, and laser and radiation therapy. For more advanced primary disease, partial or total penectomy is needed. Elective or therapeutic lymph-node dissection is recommended for inguinal metastatic disease, and depending on the disease status, unilateral or bilateral inguinal or ilioinguinal lymphadenectomy might be needed. The role of chemotherapy, as adjuvant or primary treatment in metastatic disease, needs to be defined in prospective clinical trials, which can be done in developing countries.