Laser surgery for limited superficial lesions and sophisticated radiotherapy for relatively small infiltrating tumours have been successfully employed, alone or in combination with chemotherapy. The use of radical surgery can therefore be restricted to cases which are unsuitable for conservative treatment or to relapses. Survival mainly depends on nodal metastases, but management of regional lymph nodes is controversial. Invalidating oedema is a frequent complication of inguinal lymphadenectomy. The point is to restrict the operation to patients with positive nodes.
Expectant policy can be dangerous because results of delayed lymphadenectomy are usually poor.
Fine needle aspiration biopsy and imaging may be of help in diagnosing nodal metastases. Modified surgical procedures have been advocated in order to obtain a pathological staging of the inguinal nodes avoiding invalidating sequelae, but results are controversial. Depth of invasion, tumour grade and growth pattern are of help in identifying patients at a very high risk of harbouring nodal metastases. Squamous cell carcinoma of the penis is relatively responsive to chemotherapy. However, chemotherapy alone is not curative for metastatic disease.