Clinicopathologic and outcome features of superficial high-grade and deep low-grade squamous cell carcinomas of the penis

Purpose: To report the clinicopathologic and outcome features of superficial high-grade and deep low-grade penile squamous cell carcinomas. Methods: From a retrospectively-collected series of patients with penile cancer we identified 41 cases corresponding to 12 superficial high-grade tumors and 29 deep low-grade tumors. As outcomes we evaluated inguinal lymph node status, presence of tumor relapse, final nodal status, and cancer-specific death. Follow-up ranged from 0.8 to 386.7 months (mean 152.5 months, median 157.3 months). Results: Clinicopathologic features were similar between superficial high-grade and deep low-grade tumors, except for a tendency (Fisher's exact P = 0.057) of the former to include tumors with a verruciform pattern of growth. A significantly higher proportion of inguinal lymph node metastasis was found in superficial high-grade tumors compared to deep low-grade tumors [4/5 (80%) vs. 1/5 (20%) respectively, Fisher's exact P = 0.02]. No significant differences were found regarding tumor relapse (Fisher's exact P = 0.52), final nodal status (Mantel-Cox's P = 0.42), or cancer-related death (Mantel-Cox's P = 0.52). Conclusions: Patients with superficial high-grade tumors had a significantly higher proportion of inguinal lymph node metastasis compared to patients with deep low-grade tumors. On this regard, prophylactic inguinal lymphadenectomy might be indicated in cases of superficial tumors with high-grade histology while in deeply invasive low-grade penile carcinomas a more conservative approach may be considered.