The lymphatic spread of penile cancer is primarily into the inguinal region. The first nodes involved are the sentinel lymph nodes at the conjunction of the saphenous vein with the femoral vessels, followed by the deep inguinal lymph nodes. The second areas involved are the iliac lymph nodes. For differential diagnosis one needs to consider syphilis or the soft ulcer, leucoplakia, erythroplasia, Queyrat's erythroplasia, and Bowen's disease,which is a typical precancerous penile lesion. This lesion is not malignant.
Final diagnosis depends on histological examination.
The histological pattern of penile cancer is a squamous tumor. The diagnosis should include the physical examination with biopsy before therapy is initiated. The treatment is orientated according to the TNM staging system. In case of tumor in situ, which only affects the glandular surface, the tumor can be removed or excised with the help of laser. For Stage T1 tumors, which affect the foreskin, frozen section during surgery will help in deciding if a circumcision or radical circumcision is sufficient, so that the penis itself can be preserved.