A 62-year-old man undergoes circumcision for a 1.5 cm ulcerative squamous cell carcinoma of the glans penis. Histology shows T1a tumour, grade 1, with negative margins. Inguinal nodes are clinically impalpable and ultrasound is normal. What is the appropriate management of the inguinal nodes?

• A Immediate bilateral ilioinguinal lymphadenectomy
• B Surveillance with regular inguinal examination ✓
• C Prophylactic radiotherapy to both groins
• D Chemotherapy with cisplatin and 5-fluorouracil

Explanation

For low-risk penile cancer, defined as Ta, T1a with grade 1 to 2 histology, clinically and radiologically node-negative groins are managed by surveillance, since prophylactic lymphadenectomy adds morbidity without survival gain. High-risk tumours, T2 or above or grade 3 or lymphovascular invasion, warrant dynamic sentinel node biopsy. Palpable persistent nodes after antibiotic therapy need block dissection.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.