Penile carcinoma: the case for primary lymphadenectomy

In the preceding sections, the authors have presented an approach to the management of patients with squamous-cell carcinoma of the penis selected to maximize the therapeutic benefits in high-risk patients while minimizing morbidity in low-risk patients. A clinical staging system is presented in order to approach this problem in a logical fashion. Patients with stage I penile carcinomas are all managed by eradication of the primary lesion followed by expectant management of the inguinal lymph nodes. Persistent inguinal adenopathy after treatment of the primary lesion has been a very rare occurrence in this group of patients in our experience. Patients with stage II penile carcinoma are managed by eradication of the primary lesion, 6-8 weeks of antibiotic therapy, and inguinal lymphadenectomy. The available literature suggests a high incidence of inguinal lymphatic metastases in this group of patients and supports the need for early lymphadenectomy. Finally, patients with clinical stage III disease, i.e., persistent adenopathy after eradication of the primary lesion and 6-8 weeks of antibiotic therapy, all undergo inguinal lymphadenectomy. This group is at extremely high risk and does poorly without aggressive surgical management.