Treatment of Penile Cancer in Clinically Node-Negative (cN0) High-Risk Squamous Cell Carcinoma (T1b or Higher)
This protocol addresses the management of patients with penile squamous cell carcinoma who have no palpable or suspicious lymph nodes on clinical examination (cN0), but whose primary tumour carries features placing them at high risk for micrometastatic nodal disease.
Clinical scenario: Clinically node-negative (cN0) presentation with a high-risk primary tumour — stage T1b or higher. Despite the absence of clinically detectable nodal involvement, this group is recognised as being at significant risk of harbouring occult micrometastases and warrants active nodal evaluation.
Treatment approach
Surgical lymph node staging is central to the management of this population. When staging identifies micrometastatic disease, the recommended intervention involves a targeted surgical procedure addressing the ipsilateral inguinal nodal basin — the full scope and sequence of this approach is detailed in the structured 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).
If histopathology identifies SN (micro)metastasis, ipsilateral completion ILND is indicated.
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