Penile cancer is an aggressive rare disease in Europe, occurring in 0.1 to 0.9% per 100,000 men, dominated by squamous cell carcinoma. On average, each urologist in France faces one case per year. This limited experience contributes to diagnostic delays and variable therapeutic management [1]. Risk factors include phimosis with poor hygiene, infections by the human papillomavirus, chronic inflammation, and multiple sexual partners and among other factors. Surgical intervention remains the optimal choice for treating local disease, although organ preserving procedures offer favorable aesthetic and functional outcomes with acceptable oncologic control [2]. We report a case of a penile lesion revealing a squamous cell carcinoma in a 55-year-old patient. 

Primary penile cancer is a rare tumor, with an annual incidence of approximately 1 in 100,000 to 1,000,000 men [3]. The incidence varies significantly among different geographic areas, with rates reaching up to 6% of malignancies in developing countries [4]. Over 95% of penile cancer tumors are squamous cell carcinoma (SCC), leading to significant morbidity and mortality. Risk factors include HPV infection, lack of circumcision, phimosis, lichen sclerosus, inflammation, smoking, previous UVA phototherapy, and socioeconomic status [5]. Penile cancer mostly affects older men although it occasionally also may present in younger men [6]. The rarity of this disease creates a challenge for offering the optimal treatment. The surgical approach, in advanced cases, is frequently mutilating, which can have negative impacts on the quality of life and sexual functioning of patients. We report a case of a penile lesion revealing a squamous cell carcinoma in a 55-year-old patient.

A 55-year-old patient with a history of smoking weaned 5 years ago, his medical history found a stenosis of the urethra managed surgically 1 year ago. The patient consulted for the appearance of a non-painful, proliferative lesion on the penis, affecting the glans and the prepuce. On clinical examination, the lesion was solid, reaching the body of the penis. There was an involvement of the urethra without perineal involvement (Figure 1). 

The inguinal lymph nodes were free. A squamous cell carcinoma was confirmed by the biopsy (Figure 2). We completed with a penile ultrasound and a MRI imaging that did reveal a corpus cavernosa and urethral involvement. There was no lymph nodes involvement on imaging. A thoraco-abdomino-pelvic CT scan showed no long-distance metastases staging the tumor as T3N0M0. The patient underwent a total amputation with perineal urethrostomy (Figure 3). Sentinel lymph node biopsy was negative. The follow-up was based on surveillance, and it was marked by no recurrence till 1 years and he’s still under surveillance.