Clinically Node-Negative (cN0) Penile Squamous Cell Carcinoma with High-Risk Primary Tumour
Clinical Scenario
This protocol addresses patients with penile squamous cell carcinoma who have no palpable or sonographically suspicious inguinal lymph nodes at the time of clinical evaluation — classified as clinically node-negative (cN0) — but whose primary tumour is staged at T1b or higher, placing them at elevated risk for micrometastatic lymph node involvement.
Why Lymph Node Staging Matters Here
Despite an absence of clinically detectable nodal disease, patients with a high-risk primary tumour (T1b or above) carry a meaningful probability of occult nodal metastases. Guidelines recommend offering surgical lymph node staging to all such patients, because clinical examination alone is insufficient to exclude micrometastatic spread in this setting.
Approach (Partial Overview)
The recommended strategy involves a surgical lymph node staging procedure. The sequence begins with imaging evaluation of the inguinal region, with cytological sampling where indicated, followed by a minimally invasive sentinel node technique — or an alternative surgical dissection when that technique is not accessible.
The complete staging algorithm, selection criteria, and procedural details are in the full protocol →
References
If there are no palpable/suspicious nodes (cN0) at physical examination, offer surgical LN staging to all patients at high risk of having micrometastatic disease (T1b or higher).
When surgical staging is indicated, offer dynamic sentinel node biopsy (DSNB).
If DSNB is not available and referral is not feasible, or if the patient prefers after being well informed, offer inguinal LN dissection (ILND) (open or videoendoscopic).
If DSNB is planned, perform inguinal US first, with fine-needle aspiration cytology of sonographically abnormal LNs.
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