The tumor is rare in men circumcised at birth and occurs with higher frequency in uncircumcised individuals with congenital phimosis. No single etiologic agent has been identified but the association with phimosis and the protection afforded by circumcision is thought to be due an unidentified carcinogen in smegma, which accumulates under the prepuce in uncircumcised males. HPV 16, and to a lesser extent 18, has been suggested as causal factors. In what other genital cancers do HPV subtypes play a role. Early lesions present as an ulcer, nodule or warty growth on the glans or inner surface of the prepuce.
More advanced tumors are usually large, ulcerated and fungating.
The presence of a prepuce may obscure the tumor until it is well advanced. Most patients are reluctant to seek early medical attention, and tumors are often advanced at the time of presentation with extensive destruction of the organ. Squamous cell carcinoma of the penis. Fungating lesion with complete destruction of the glans. The tumor may invade deeply and extend along the shaft, destroying portions of it.