Pathologic Features of Invasive Penile Carcinomas and Precursor Lesions

Penile cancer is rare in the United States, but highly prevalent in South America, Africa, and some regions of Asia. Most patients present in their fifties to seventies with a mean age of 58 years. Several risk factors have been identified and include HPV infection, phimosis, cigarette smoking, and lichen sclerosus. Most penile carcinomas are squamous cell carcinomas, and the glans is the preferred site of origin, followed by the foreskin and coronal sulcus. Macroscopically, tumors can be exophytic, endophytic, or ulcerative. Histologically, penile squamous cell carcinoma is subclassified into HPV-unrelated and HPV-related. In the former group, usual, verrucous, papillary, cuniculatum, sarcomatoid, pseudohyperplastic, pseudoglandular, adenosquamous, and mucoepidermoid subtypes have been described. Basaloid, warty, warty-basaloid represent the most common HPV-related subtypes. Biologic behavior is mainly related to histological subtype, histological grade, tumor thickness/depth of invasion, and presence of perineural invasion. Surgical resection is the standard treatment; adjuvant radiation, chemotherapy, and other modalities are offered in advanced cases.