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The role of circumcision in partially protecting against sexually transmitted infections (STIs) and other dermatoses has been documented. Neonatal circumcision is not routinely practiced in South America. Although it is logical to assume that male genital dermatoses are more prevalent in Hispanic men, they are underrepresented in the existing literature. Objective: To describe the epidemiological characteristics from our male genital dermatology unit in Montevideo (Uruguay), the diagnoses, and correlate them with circumcision status and comorbidities. Methods: A retrospective observational cohort study was conducted. A dermatologist and urologist evaluated all patients using standard questionnaires. In 3 years and 8 months, 269 patients were seen. Median age was 41, prevalence of neonatal circumcision was 0.7%, HIV was 4.2%, STIs were 24.9%, non-STIs were 63.9%, and both (STI + non-STI) were 11.2%. Most frequent entities: eczema/balanoposthitis (27.1%), condyloma (24.9%), and lichen sclerosus (15.6%). Data correlating circumcision and other diagnoses did not reach statistical significance. HIV was positively associated with other STIs ( p < 0.05), and an association with balanoposthitis was seen; however, it did not reach statistical significance ( p < 0.1). Main limitation was small sample size. This is the first study of its kind based on Hispanic patients. Collaboration between specialties proved to be fundamental. Further studies are needed in this demographic to find an association between circumcision, comorbidities, and genital dermatoses.

Introduction and objectives:The local recurrence rate of penile cancer following surgical excision is reported in many series to be between 6 and 29%. Intra-operative frozen section (FS) is a useful tool to ensure safe microscopic margins in organ-sparing procedures in penile cancer. In this series, we assessed the rates of positive margins and patterns of local recurrence in a multicentre cohort of patients undergoing penile-preserving surgery assisted by intra-operative FS analysis.Materials and methods:We reviewed all those patients for whom intra-operative FS was employed during penile-preserving surgery in three tertiary referral centres between 2003 and 2016. We assessed whether the use of FS altered the surgical technique and what affect it had on positive margins and recurrence rates.Results:A total of 169 patients were identified. Of these, intra-operative FS examination of the surgical margin was positive in 21 (12%) cases. Final histological examination confirmed cancer-free margins in all but one patient (99.4%). Overall, 9 patients developed local recurrence (5.3%).Conclusions:In this series, intra-operative FS contributed to a very low rate (5.3%) of local recurrence. We noted an extremely low positive margin rate (0.6%) which highlights the benefit of incorporating FS analysis into organ-preserving surgery for penile cancer.Level of evidence:Not applicable for this multicentre audit.

The aim of this study was to describe pathologic features found at autopsy of 14 patients with penile cancer. Nine patients died from disseminated disease; 5 of them presented local/regional recurrences. Five patients died from other causes, 2 of them postoperatively. Local recurrence sites were corpus cavernosum, Buck’s fascia and urethra, regional skin, and prostate. Metastatic sites were lymph nodes (9 cases), liver (7 cases), lungs (6 cases), heart (5 cases), adrenals, bone and skin (3 cases each), thyroid and brain (2 cases each), and pancreas, spleen, and pleura (1 case each). Patients with heart metastasis had arrhythmias. Patients who died and who did not die from penile cancer had different profiles: low-grade superficial tumors with usual and warty subtypes versus high-grade deeply invasive basaloid or hybrid verrucous/sarcomatoid carcinomas. A natural history model for penile cancer routes of spread is proposed: local intrapeneal, regional and systemic nodes, regional skin, liver, lungs, heart, and other multiple sites.

Penile cancer, albeit an uncommon malignancy, commonly affects men aged between 50 and 70 years, often with a history of predisposing factors such as Bowen's disease or leukoplakia. We describe a case of early invasive squamous cell carcinoma of the penis in a 39-year-old man with no history of predisposing factors, treated by a partial glansectomy.

Mr Harper and colleagues1 (January 2002 JRSM) report an unusual case of colonic adenocarcinoma presenting with a penile metastasis. We have studied the pathology of secondary neoplasms of the genitourinary tract in a series of some 27 000 necropsies at the Royal London Hospital2,3. Secondary malignancies of the penis are much less common than those of other sites in the genitourinary tract: there were 425 secondary tumours of the kidney, 155 of the bladder, 24 of the prostate, 14 of the testis, and only 5 of the penis. These 5 cases were from necropsies of men who died between the ages of 51 and 74 years. 2 were metastatic pancreatic adenocarcinomas, 2 were metastatic transitionalcell carcinomas of the bladder, and 1 a prostatic adenocarcinoma that reached the bulb of the penis by direct spread. The histological appearances were of diffuse infiltration, by tumour cells, of the vascular spaces of the corpora cavernosum and spongiosum. All had metastatic disease elsewhere. Vascular spread seems to be the usual route of metastases to the penis, though their rarity in so vascular an organ suggests that it is an unpermissive environment for tumour growth4.

A short account on malignant polyblastomatosis is given and a case of epithelioma of the penis associated with gastric carcinoma in a luetic man 48 years old is described. A lung metastasis from the penis epithelioma and liver, lymph nodes, pleura, microscopic lung metastases from the gastric carcinoma were present. The presence of lung metastases from both tumours is pointed out as a contribution to the knowledge of multiple tumours metastases; the interest of the lung metastasis from a cancer of the penis more than 1 year after radical surgery is emphasized. The occurrence of the cancer of the penis may have been favoured by syphilis, which cannot be regarded as a predisposing factor to the polyblastomatosis.

In a series of 720 malignant melanomas there was one case of primary malignant melanoma of the penis, in a 43-year old patient. He was subjected to total amputation of the organ together with the inguino-iliac lymph nodes and endolymphatic radiotherapy with 131I Lipiodol.