Injectable substances, such as mineral oil and silicone, have been widely used for breast and penile augmentation. Many cases of penile injection with mineral oil and silicone have been reported but no association with malignancy has been found to date. We report on a patient who had squamous cell carcinoma of the penis 35 years after a mineral oil injection and underwent successful penile salvage. CASE REPORT A 55-year-old circumcised man presented with a large penile mass, which had grown progressively ever since a single self-injection of mineral oil into the penile shaft skin 35 years earlier. The patient complained of a 3-month history of pain and discharge from the mass. A 15 cm. mobile, ulcerated mass was palpated in the penile region with the glans penis invaginated centrally (part A of figure). There was induration of the anterior scrotal wall but both testicles were palpably normal. Multiple subcutaneous lower abdominal nodules and shoddy inguinal lymphadenopathy were noted. Computerized tomography (CT) of the abdomen and pelvis confirmed the findings and revealed no pelvic lymphadenopathy. Excisional biopsy of several subcutaneous abdominal nodules and core needle biopsy of the upper scrotal mass revealed only inflammation and foreign body reaction, while incisional biopsies of the deep penile mass demonstrated squamous cell carcinoma. Chest radiography and CT revealed multiple calcified granulomas in both lungs. Cystoscopy, complete blood count, serum chemistry evaluation, liver function tests and urinalysis were normal. After antibiotic therapy, surgical excision was performed, beginning at the border of the indurated region. The hypervascular and heterogeneously calcified mass was dissected free from the underlying and uninvolved penile shaft and glans (parts B and C of figure). Frozen section revealed negative surgical margins and permanent section revealed a 1.1 cm. tumor-free margin around the 6.5 3 4.0 cm. malignant tumor. Inguinal lymph nodes were not biopsied. After 4 days, split thickness skin grafting to the penile shaft was performed. Pathological examination revealed well differentiated stage T1 squamous cell carcinoma of the penile skin with lipogranulomas and an intense foreign body reaction. At 4-week followup the skin graft was well healed, and the patient reported normal voiding and normal erections (part D of figure). At 6-month followup there was no interval change in the inguinal lymph nodes, and no evidence of disease recurrence on local or metastatic evaluation. Chest radiography and CT of the abdomen and pelvis were unchanged. DISCUSSION