Where should a patient with bumps on the penis be referred for primary care?

From the Guidelines

A patient with bumps on the penis should be referred to a urologist for primary care evaluation, as the most recent and highest quality study suggests that urologists play a crucial role in the management of penile lesions, including those that may be cancerous 1. The appropriate specialist depends on the suspected cause of the bumps, which may include common conditions like genital warts (caused by HPV), molluscum contagiosum, pearly penile papules, or Fordyce spots.

• More serious conditions requiring prompt evaluation include herpes, syphilis, or rarely, penile cancer.
• While waiting for the specialist appointment, the patient should avoid sexual contact or use barrier protection to prevent potential transmission of infectious causes.
• The patient should not attempt self-treatment with over-the-counter medications before professional evaluation, as this could mask symptoms or cause irritation. Proper diagnosis typically requires visual examination by a specialist and possibly additional testing such as biopsy, culture, or blood tests for sexually transmitted infections, as recommended by the European Association of Urology-American Society of Clinical Oncology collaborative guideline on penile cancer: 2023 update 1.
• Early evaluation is important both for the patient's peace of mind and because some conditions are more effectively treated when caught early. The guideline also emphasizes the importance of a detailed physical examination of the penis and external genitalia, recording the morphology, size, and location of the penile lesion, including the extent and invasion of penile (adjacent) structures 1.
• Additionally, the guideline recommends performing magnetic resonance imaging (MRI) of the penis/primary tumour when there is uncertainty regarding corporal invasion and/or the feasibility of (organ-sparing) surgery.
• A pretreatment biopsy of the primary lesion is also recommended when malignancy is not clinically obvious, or when nonsurgical treatment of the primary lesion is planned.

From the Research

Referral for Primary Care

For a patient with bumps on the penis, referral to a primary care physician (PCP) or a specialist such as a urologist or dermatologist may be necessary. The following points should be considered:

• The patient's symptoms and medical history should be evaluated to determine the appropriate course of action 2.
• Genital dermatology can be a challenging field, and diagnosis and management may require specialized knowledge and training 3, 4, 5.
• Common penile lesions can be benign or malignant, and proper diagnosis and treatment are essential to prevent complications 6.

Specialist Referral

Referral to a specialist such as a urologist or dermatologist may be necessary if:

• The patient's symptoms are severe or persistent 2.
• The patient has a history of genital dermatologic lesions or other urologic conditions 3, 4, 5.
• The patient's lesion is suspicious for malignancy or requires further evaluation 3, 5, 6.

Primary Care Physician (PCP) Referral

A PCP can provide initial evaluation and management of the patient's symptoms, and refer to a specialist if necessary. The PCP can:

• Evaluate the patient's symptoms and medical history 2.
• Provide guidance on self-care and management of symptoms 2.
• Refer the patient to a specialist such as a urologist or dermatologist if necessary 2, 3, 4, 5, 6.