Penile squamous cell carcinoma related to high risk HPV infection

Erliana Tantri Harsono; Agnes Sri Siswati; Sonia Diovani; Raden Roro Rini Andayani; Dyah Ayu Mira Oktarina

doi:10.22146/inajbcs.v57i2.17119

Erliana Tantri Harsono Department of Dermatology, Venereology and Aesthetic, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
Agnes Sri Siswati Department of Dermatology, Venereology and Aesthetic, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
Sonia Diovani Department of Dermatology, Venereology and Aesthetic, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
Raden Roro Rini Andayani Department of Dermatology, Venereology and Aesthetic, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
Dyah Ayu Mira Oktarina Department of Dermatology, Venereology and Aesthetic, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia

DOI: https://doi.org/10.22146/inajbcs.v57i2.17119

Keywords: squamous cell carcinoma, penile neoplasm, hpv infection, diagnosis, clinical presentation

Abstract

Penile cancer is an uncommon form of malignancy, with squamous cell carcinoma (SCC) being the most common subtype. Human papillomavirus (HPV) infection is strongly associated with the development of penile SCC, particularly strains 16 and 18. This report presents two cases of penile SCC related to HPV type 18 infection and discusses the diagnosis and role of HPV in penile cancer. It aims to illustrate the clinical presentation and diagnostic challenges of penile SCC, with emphasis on the role of HPV infection. Case 1 involves a 41 yo man with a verrucous mass on the glans penis, diagnosed as well-differentiated SCC, with HPV type 18 detected. Case 2 is a 54 yo man presenting with multiple ulcerative plaques on the distal glans, also diagnosed as SCC with HPV type 18. Penile SCC can be classified into HPV-associated and non-HPV-associated subtypes. The HPV-associated SCC, more commonly seen in younger patients, is driven by viral oncogenes E6 and E7, which disrupt tumor suppressor proteins. The pathogenesis is similar to that seen in cervical cancer. Diagnosis is confirmed through histopathology and genotyping, while treatment involves surgical excision, with possible radiotherapy and chemotherapy depending on lymph node involvement. Early detection and diagnosis of penile SCC are critical for effective treatment. The HPV infection plays a significant role in the pathogenesis of penile SCC, highlighting the importance of HPV vaccination in prevention. Multidisciplinary management is essential for improving patient outcomes

References

Thomas A, Necchi A, Muneer A, Tobias-Machado M, Tran ATH, Van Rompuy AS, et al. Penile cancer. Nat Rev Dis Primers 2021; 7(1):11.

https://doi.org/10.1038/s41572-021-00246-5

Engelsgjerd JS, Leslie SW, LaGrange CA. Penile cancer penile intraepithelial neoplasia. 2024. Statpearls. Treasure Island: StatPearls Publising, 2025.

Thumma N, Pitla N, Gorantla V, du Plessis M. A comprehensive review of current knowledge on penile squamous cell carcinoma. Front Oncol, 2024;14.

https://doi.org/10.3389/fonc.2024.1375882

Ferrándiz-Pulido C, de Torres I, García-Patos V. Penile squamous cell carcinoma. Actas Dermosifiliogr, 2012; 103(6):478-87.

https://doi.org/10.1016/j.ad.2011.08.008

Marchionne E, Perez C, Hui A, Khachemoune A. Penile squamous cell carcinoma: a review of the literature and case report treated with Mohs micrographic surgery. An Bras Dermatol, 2017; 92(1):95-9.

https://doi.org/10.1590/abd1806-4841.20175009

Hakenberg OW, Dräger DL, Erbersdobler A, Naumann CM, Jünemann KP, Protzel C. The diagnosis and treatment of penile cancer. Dtsch Arztebl Int, 2018; 115(39):646-52.

https://doi.org/10.3238/arztebl.2018.0646

Ribera-Cortada I, Guerrero-Pineda J, Trias I, Veloza L, Garcia A, Marimon L, et al. Pathogenesis of penile squamous cell carcinoma: molecular update and systematic review. Int J Mol Sci 2021; 23(1):251.

https://doi.org/10.3390/ijms23010251

Trianto HF, Rahaju AS. Tinjauan literatur: patogenesis infeksi human papillomavirus sebagai dasar dalam pengembangan pencegahan dan terapi baru pada kanker penis. Majalah Kesehatan 2021; 8(3):171-81.

https://doi.org/10.21776/ub.majalahkesehatan.2021.008.03.7

Anderson S, Breen KJ, Davis NF, Deady S, Sweeney P. Penile cancer in Ireland - a national review. Surgeon 2022; 20(3):187-93.

https://doi.org/10.1016/j.surge.2021.04.004

Marchioni M, Berardinelli F, De Nunzio C, Spiess P, Porpiglia F, Schips L, et al. New insight in penile cancer. Minerva Urol Nefrol 2018; 70(6):559-69.

https://doi.org/10.23736/S0393-2249.18.03215-0

Heppt MV, Schlager G, Berking C. Epithelial Precancerous Lesions. In: Kang S, Amagai M, Bruckner AL, Enk AH, Margolis DJ, McMichael AJ, et al., editors. Fitzpatrick's dermatology. 9th ed. Philadelphia: McGraw-Hill Education; 2019. p. 1857-83.

Palaniappan V, Karthikeyan K. Bowen's disease. Indian Dermatol Online J, 2022; 13(2):177-89.

https://doi.org/10.4103/idoj.idoj_257_21

Irshad U, Puckett Y. Giant Condylomata Acuminata of Buschke and Lowenstein. 2023. StatPearls. Treasure Island: StatPearls Publishing; 2025.

Purzycka-Bohdan D, Nowicki RJ, Herms F, Casanova JL, Fouéré S, Béziat V. The pathogenesis of giant condyloma acuminatum (Buschke-Lowenstein tumor): an overview. Int J Mol Sci, 2022; 23(9):4547.

https://doi.org/10.3390/ijms23094547

Spiess PE, Dhillon J, Baumgarten AS, Johnstone PA, Giuliano AR. Pathophysiological basis of human papillomavirus in penile cancer: key to prevention and delivery of more effective therapies. CA Cancer J Clin, 2016; 66(6):481-95.

https://doi.org/10.3322/caac.21354