Penile Cancer

Most penile cancers are squamous cell carcinomas arising from the epithelial lining of the penis. High-risk human papillomavirus (HPV) can drive abnormal epithelial change, while chronic inflammatory disease such as lichen sclerosus repeatedly injures the tissue and promotes malignant transformation. The result may begin as a small, localized lesion but can progress into deeper structures and spread through lymphatic channels to the inguinal nodes. A lesion can be painless in its early stages. That absence of pain is not reassuring if the area remains abnormal, enlarges, ulcerates, bleeds, or becomes firm or fixed. Penile cancer is uncommon in Canada—approximately 200 new cases and 30 deaths occur annually—and incidence peaks between 65 and 74 years, but age alone should not determine whether a lesion is investigated. The nurse’s first clinical impression comes from looking carefully, not from assuming that a genital lesion is an infection. Balanitis, dermatitis, candidiasis, sexually transmitted infections, and benign HPV-related warts can all cause redness, irritation, or ulceration. A persistent, indurated, enlarging, bleeding, or ulcerated lesion needs tissue diagnosis even when an infection also seems plausible.