A 70-year-old, circumcised man sought medical attention due to the gradual development of a “lesion” on the ventral aspect of the penis. About 4 years had elapsed from the initial manifestation until the present. The patient did not have a history of genital warts.
Key point: There is a rather large erythematous patch/plaque present. However, an exophytic, verrucous nodule is visible at the inferior border of the tumor (green arrow). Biopsy of the flatter portion of this lesion disclosed squamous cell carcinoma in-situ, while biopsy of the nodule revealed invasive squamous cell carcinoma.
Treatment: Moh’s micrographic surgery was performed to ensure complete removal but allow for tissue sparing. The resulting defect was quite large, but cosmetically repairable.
Note: The alternative treatment would have been penectomy. The patient was willing to risk the potential for a slightly lower cure rate to preserve penile form and function.