Penile Cancer and Penile Intraepithelial Neoplasia

Abstract

There is evidence that high-risk human papillomaviruses (HPVs), particularly HPV16, have a pathogenic role in about 45–50% of penile carcinoma. Very similar to the pathogenesis of vulvar cancer, there may be two etiologies for penile cancer, one HPV-related and the other due to non-HPV-related factors, such as lichen sclerosus and other chronic inflammatory diseases. Most likely, the pathogenesis reflects several steps of events over some decades from precursor lesions to squamous cell cancer. Increased attention has to be paid to the recognition of early stages of penile cancer and premalignant lesions, especially the flat and very flat lesions. Preventive measures include topical treatment of warts, destruction or surgical excision of intraepithelial lesions. Prevention is also in line with a careful treatment of inflammatory conditions such as lichen sclerosus and surgical correction of phimosis. Furthermore, neonatal circumcision, prevention of phimosis, smoking cessation and avoiding UV and dermatologic psoralen and UVA exposition of external genitals should be promoted. The prevalence of HPV16 and HPV18 in penile cancer and precursor lesions suggests that available HPV vaccines are possibly effective to substantially reduce the burden of the disease. This, however, depends on the dissemination of the HPV vaccines to a large part of the young males in the different populations.