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Penile squamous cell carcinoma (SCC) is uncommon in Europe, where it accounts for approximately 0.7% of all malignant tumors in men. The main risk factors are poor hygiene, lack of circumcision, human papillomavirus (HPV) infection, and certain chronic inflammatory skin diseases. HPV infection is detected in 70% to 100% of all penile in situ SCCs and in 30% to 50% of invasive forms of the disease, mainly basaloid and warty SCCs. In situ tumors can be treated conservatively, but close monitoring is essential as they become invasive in between 1% and 30% of cases. The treatment of choice for penile SCC is surgery. Inguinal lymph node irradiation is no longer recommended as a prophylactic measure, and it appears that selective lymph node biopsy might be useful for reducing the morbidity associated with prophylactic inguinal lymph node dissection. Survival is directly related to lymph node involvement. Improving our knowledge of underlying molecular changes and their associated genotypes will open up new therapeutic pathways., (Copyright © 2011 Elsevier España, S.L. and AEDV. All rights reserved.)

Erythroplasia of Queyrat of the glans penis developed in a 79-year-old uncircumcised man on a background of biopsy proven Zoon's plasma cell balanitis affecting the same site on the glans. The Zoon's plasma cell balanitis had been treated with topical pimecrolimus for 1 month prior to the development of clinically evident erythroplasia of Queyrat. He was subsequently treated with topical 5-fluorouracil 5% for 2 weeks, which resulted in clinical clearance. He has since been circumcised.

Squamous cell carcinoma of the penis is an uncommon cancer, though in one study it accounted for 90% of all penile cancers. Its association with balanitis xerotica obliterans (BXO) is a rare though recognized occurrence. We describe a case of a 46-year-old Caucasian male who first presented to our open-access clinic with a mild phimosis. An elective circumcision was performed and histological examination of the circumcision specimen showed BXO. He was lost to follow-up but re-presented three years later with a persistent tender penile ulcer which on biopsy showed no obvious sinister pathology. He returned a further two years later with a short history of bleeding from the ulcer, and another biopsy now confirmed penile squamous cell carcinoma. Our case emphasizes the importance of regular review of patients with BXO, in particular those with persistent symptoms.

Penile squamous cell carcinoma arising from balanitis xerotica obliterans is rarely reported. We describe a 58-year-old man in whom penile squamous cell carcinoma developed after 25 years of observation for balanitis xerotica obliterans. It is important to recognize the possibility of this uncommon complication of balanitis xerotica obliterans, because survival of patients with squamous cell carcinoma depends on early diagnosis and treatment.

Squamous cell carcinoma arising from balanitis xerotica obliterans is rarely reported. We describe an 83-year-old man in whom metastatic penile squamous cell carcinoma developed after 18 years of observation for balanitis xerotica obliterans. It is important to recognize the possibility of this uncommon complication of balanitis xerotica obliterans, because survival of patients with squamous cell carcinoma depends on early diagnosis and treatment.

Two cases of squamous cell carcinoma of the prepuce arising on balanitis xerotica obliterans are described. This event is unusual and not well known. The surgical treatment was a wide circumcision in which the prepuce and part of the shaft skin were removed, performing as well a decortication of the glans base. This technique seemed to be satisfactory in removing the carcinoma and obtaining a definite improvement in the clinical picture of balanitis xerotica obliterans as well.

A 33 year old uncircumcised Caucasian male who had a 7 year history of intermittent erosive balanitis and herpes, presented with an 18 month history of progressively worsening penile ulceration not responding to the usual medication. Biopsy of the glans penis carried out in view of the long standing ulceration showed a sqamous cell carcinoma of the penis. As there was no response to radiotherapy, partial penectomy was carried out. The importance of early biopsy is emphasised when ulcerative lesions of the penis do not respond adequately to medical therapy. Different treatment modalities available are reviewed.

Three cases of glans penis epidermoid carcinoma after lichen sclerosus et atrophicus (LSA) or balanitis xerotica obliterans are discussed. Relationships between both diseases are analyzed but remain unclear. Balanitis xerotica obliterans causes foreskin and urethral meatus stenosis that requires circumcision. Glans penis carcinoma can be observed many years later even after circumcision. The knowledge of LSA is important to do circumcision at the beginning of the disease with a long-term follow-up of these patients to realize a glans penis biopsy if necessary. Most cases of LSA are not recognized, and the frequency is higher than reported.

A man who had been circumcised in adulthood developed, in sequence, balanitis xerotica obliterans (lichen sclerosus et atrophicus), multiple dysplastic keratoses, and a superficial, well-differentiated squamous-cell carcinoma on the glans penis. Squamous-cell carcinoma that develops after circumcision in adulthood tends to be more aggressive in biologic behavior and more malignant-looking in histology. Cancer developing within lesions of lichen sclerosus et atrophicus has been reported rarely.

Two cases of glans penis epidermoid carcinoma after lichen sclerosus and atrophicus or balanitis xerotica obliterans are discussed. Relationship between both diseases are analysed but remain not clear. Balanitis xerotica obliterans gives foreskin and urethral meatus stenosis that required circumcision. Glans carcinoma can be observed many years later even after circumcision. The knowledge of lichen sclerosus and atrophicus is important to do circumcision at the beginning of the disease with a long term follow-up of these patients to realize a glans penis biopsy if necessary. Most of lichen sclerosus and atrophicus are not recognized and the frequency would be higher than reported.