Penile Squamous Cell Carcinoma Clinicopathological Features, Nodal Metastasis and Outcome in 333 Cases Gustavo Cardoso Guimarães, Isabela Werneck Cunha, Fernando Augusto Soares, Ademar Lopes, Jose Torres, Alcides Chaux, Elsa F. Velazquez, Gustavo Ayala and Antonio L. Cubilla* From the Hospital do Cancer A. C. Camargo (GCG, IWC, FAS, AL), São Paulo, Brazil, Brigham and Women’s Hospital, Harvard Medical School (EFV), Boston, Massachusetts, Baylor College of Medicine (GA), Houston, Texas, and Instituto de Patología e Investigación and Facultad de Ciencias Medicas, Universidad Nacional de Asunción (JT, AC, ALC), Asuncion, Paraguay Abbreviations and Acronyms HPV = human papillomavirus NOS = not otherwise specified SCC = squamous cell carcinoma Submitted for publication December 30, 2008. * Correspondence: Instituto de Patología e In- vestigación, Martin Brizuela 325, Asuncion, Par- aguay (telephone: 595 21 208963; FAX: 595 21 214055; e-mail: acubilla@institutodepatologia. com.py). Purpose: We evaluated clinicopathological features and outcomes in patients with penile squamous cell carcinoma. Materials and Methods: We studied 333 patients with homogeneous surgical treatment, including circumcision in 4, local excision in 2, partial penectomy in 194 and total penectomy in 133. Of the patients 153 also underwent bilateral groin dissection. Followup was 8 to 453 months (average 100). Results: The usual type of squamous cell carcinoma was noted in 65% of cases. Higher histological grade, deeper anatomical infiltration, and vascular and perineu- ral invasion were common findings in sarcomatoid, basaloid and adenosquamous carcinoma cases, correlating with a higher rate of nodal metastasis and mortality. These features were unusual in verrucous, papillary and warty carcinoma cases. Recurrence in 22% of cases was common for the sarcomatoid, basaloid and adeno- squamous types but was not noted for verrucous carcinoma. Locoregional relapse was more common in cases of usual, mixed, papillary and warty carcinoma, and systemic relapse was typical in sarcomatoid and basaloid carcinoma cases. The overall metastasis rate was 24% and the 10-year survival rate was 82%. The highest mortality rate was observed within the first 3 years of followup. High grade tumors were more common in penectomy cases and carcinoma exclusive of the foreskin had a better prognosis. The nodal metastasis risk groups were low—verrucous, papillary and warty, intermediate— usual and mixed, and high risk—sarcomatoid, basaloid and adenosquamous. Mortality risk groups were low—mixed, papillary and warty, intermediate— usual and basaloid, and high risk—sarcomatoid. Conclusions: These data should help clinicians to design therapeutic strategies and followup protocols. Key Words: penis; carcinoma, squamous cell; neoplasm recurrence; neoplasm metastasis; groin MOST malignant penile tumors are carcinoma originating in the special- ized membranous squamous cell epi- thelium covering the glans, coronal sulcus and inner preputial surface. 1 Tumors arising in the outer skin of the foreskin and shaft are exceedingly rare. Although SCC at various sites is generally histologically similar, there is a wide spectrum of clinically, patho- logically and perhaps etiologically dis- tinctive SCC subtypes with a distri- bution that may be organ and site related. The WHO histological sub- classification of penile SCC recognizes 7 special tumors and a mixed catego- 528 www.jurology.com 0022-5347/09/1822-0528/0 Vol. 182, 528-534, August 2009 THE JOURNAL OF UROLOGY ® Printed in U.S.A. Copyright © 2009 by AMERICAN UROLOGICAL ASSOCIATION DOI:10.1016/j.juro.2009.04.028