Approximately 20% of patients with squamous cell carcinoma of the penis who have nonpalpable nodes also have occult inguinal lymph node metastases, and inguinal lymphadenectomy can be curative in these patients.3 Cross-over of the lymphatic vessels at the base of the penis can allow contralateral metastases to occur. While observation with delayed lymphadenectomy would avoid unnecessary lymphadenectomy, survival is lower in patients who have delayed lymphadenectomy. High-grade tumors that are T2 or greater have an increased likelihood of inguinal nodal metastases and would benefit from prophylactic lymphadenectomy.
- Immediate bilateral superficial inguinal lymphadenectomy.
3. Lynch DF, Pettaway CA. Tumors of the penis. In: Walsh PC, Retik AB, Darracott Vaughn E, Wein AJ, editors. Campbells urology. 8th ed. Philadelphia: Elsevier; 2002:2945.
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