From the Guidelines
The management of penile lesions should prioritize a thorough assessment, including visual examination, patient history, and diagnostic tests, followed by treatment based on the underlying cause, with a focus on organ-preserving surgery and timely lymph node management, as recommended by the most recent guidelines 1. The approach to managing penile lesions involves several key steps, including:
- A detailed physical examination to assess the morphology, size, and location of the penile lesion, as well as its relationship to adjacent structures 1
- Diagnostic tests, such as biopsy, to determine the underlying cause of the lesion 1
- Treatment options, which may include topical medications, surgical excision, laser therapy, or organ-preserving surgery, depending on the cause and severity of the lesion 1
- Timely lymph node management, including dynamic sentinel node biopsy (DSNB) or inguinal lymph node dissection (ILND), to assess for metastasis and guide treatment 1 Some specific treatment options for penile lesions include:
- Topical medications, such as imiquimod or 5-fluorouracil, for premalignant lesions like penile intraepithelial neoplasia 1
- Organ-preserving surgery, such as circumcision, wide local excision, or glans resurfacing, for lesions confined to the glans and prepuce 1
- Partial or total penectomy, with or without reconstruction, for more advanced lesions or those that have invaded the corpora cavernosa 1
- Radiotherapy, which may be offered to selected patients with biopsy-confirmed T1 or T2 lesions 1 It is essential to note that the management of penile lesions should be individualized, taking into account the patient's preferences, comorbidities, and the specific characteristics of the lesion. Patient education about the condition, treatment expectations, and prevention of transmission (for infectious causes) is also crucial for comprehensive management 1.
From the Research
Management Approach for Penile Lesions
The management of penile lesions depends on the underlying cause, which can range from infectious to non-infectious etiologies.
- Infectious causes include herpes simplex virus, syphilis, chancroid, lymphogranuloma venereum, and granuloma inguinale (donovanosis) 2.
- Non-infectious causes can include sexual trauma, psoriasis, Behçet syndrome, and fixed drug eruptions 2.
Diagnostic Tests
Diagnostic tests are essential in determining the cause of penile lesions.
- Serologic tests for syphilis and darkfield microscopy or direct fluorescent antibody testing for Treponema pallidum should be considered in all patients 2.
- Culture or polymerase chain reaction test for herpes simplex virus and culture for Haemophilus ducreyi may also be necessary 2.
Treatment Options
Treatment options vary depending on the cause of the penile lesion.
- For herpes simplex virus infection, treatment typically involves oral acyclovir, famciclovir, or valacyclovir 2, 3.
- Syphilis is usually treated with a single dose of intramuscular penicillin G benzathine 2.
- Chancroid can be treated with a single dose of intramuscular ceftriaxone or oral azithromycin, ciprofloxacin, or erythromycin 2.
- Penile warts, caused by human papillomavirus, can be treated with patient-administered therapies such as podofilox, imiquimod, or sinecatechins, or clinician-administered therapies like cryotherapy or surgical excision 4, 5.
Premalignant Penile Lesions
Premalignant penile lesions require early detection and treatment to prevent progression to penile cancer.