Balanitis xerotica obliterans
Human papillomavirus (HPV) infection
Loss of rete pegs
Viral etiologic agents
Coxsackievirus type 23
Human herpesvirus (HHV) type 8
HPV type 16
HPV type 32
Haemophilus ducreyi (chancroid [soft chancre])
Daily genital hygiene
Avoiding cigarette smoke
Circumcision before puberty
Avoiding sexual promiscuity
Circumcision after 21 years of age
Phimosis may obscure the nature of the lesion.
Cancer cells reach the contralateral inguinal region because of lymphatic cross-communications at the base of the penis.
Cancer may develop anywhere on the penis.
Penetration of the Buck fascia and the tunica albuginea by the tumor permits invasion of the vascular corpora.
Because of the associated discomfort, patients usually present to physicians within the first month of noting the lesion.
No disfiguring therapy is indicated, because spontaneous remissions have been noted in approximately 10% of cases.
DNA flow cytometry should be performed on virtually all specimens because it provides crucial information.
Radiologic studies play no role in decision making.
Adequate biopsies to determine stage are unimportant because all patients should be treated with amputation.
Tumor stage grade and vascular invasion status all provide prognostically important information.
Lymphatic drainage from the primary tumor is ipsilateral alone in most cases.
Metastases from the primary tumor often involve lung, liver, or bone as initial sites.
Metastasis initially involves inguinal lymph nodes beneath the fascia lata.
Metastasis initially involves inguinal lymph nodes above the fascia lata.
Metastasis often initially involves spread from the corpora cavernosa to the pelvic lymph nodes.
It may be due to the action of parathyroid hormone–like substances released from the tumor.
It is related to the action of osteoblasts on bone formation.
It is managed with aggressive diuretic administration as first-line therapy.
It is more commonly due to massive bone metastases than bulky soft tissue metastases.
It is often related to uremia due to ureteral obstruction.
CT may be beneficial in detecting enlarged inguinal nodes in obese patients or those who have had prior inguinal therapy.
Inguinal palpation is preferred to CT and lymphangiography for determining inguinal nodal status.
CT is not an appropriate test for determining primary tumor stage.
Both ultrasonography and MRI lack sensitivity for the detection of corpus cavernosum involvement.
Lymphangiography can detect abnormal architecture in normal-sized lymph nodes.
Stage T1 tumors may involve the urethra at the meatus.
Large verrucous carcinomas are considered stage Ta.
Lymph node stage is based on the resectability of involved nodes.
Primary tumor stage is based on the size of the primary lesion.
Stage T2 tumors are based on biopsy and involve corpora cavernosa only.
The grade of the primary tumor
The extent of lymph node metastasis
The stage of the primary tumor
The presence of lymph node metastasis
Vascular invasion presence in the primary tumor
No positive pelvic lymph nodes
A single metastasis of only 6 cm
No more than two positive inguinal lymph nodes
Absence of extranodal extension of cancer
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