Premalignant lesions present a particularly unique challenge in penile cancer. They can be difficult to distinguish from other benign dermatoses and have an uncertain natural history. A tendency for delayed presentation, with an all too common history of long-term self management, or unsuccessful treatment, often results in a relatively treatable premalignant lesion progressing to an invasive carcinoma, requiring more aggressive surgery, with poorer outcomes.

A better understanding of the risk factors involved in the development and progression of premalignant lesions is essential. Effective early recognition and treatment before invasion would provide the best approach to the management of these lesions. The current understanding of penile cancer is based on small, nonrandomized, retrospective studies due to the rarity of this malignancy. However, with the introduction of specialist penile cancer centers, our knowledge of the biological behavior and management of this rare neoplasm has progressed.

Several risk factors have been associated with penile cancer. These include the presence of a foreskin, phimosis, poor hygiene, smoking, chronic inflammation, and having multiple sexual partners. One of the most important and widely studied risk factors in genital tumors is the role of human papilloma virus (HPV) infection. Progress in our understanding of its association with penile cancer has shed light onto its pathogenesis and progression from in situ disease to invasive malignancy.

Department of Urology, Institute of Urology, University College London Hospital, London, UK

A. Muneer et al. (eds.), Textbook of Penile Cancer,

DOI 10.1007/978-l-84882-879-7_5, © Springer-Verlag London Limited 2012

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