Epidemiology and natural history

This chapter discusses the epidemiology and the natural history of invasive penile cancers, which for the majority involve the squamous mucosal epithelium of the glans, coronal sulcus, and inner preputial surfaces. Epidemiologic data and age-standardized incidence rates of penile cancer in different geographical areas of the world are presented. The etiologic role of phimosis, human papillomavirus infection, lichen sclerosus, psoralen and ultraviolet A photochemotherapy, and penile trauma is reviewed. The impact of risk factors such as socioeconomic status, religion, sexual practices, and other habits, including poor genital hygiene of different racial and ethnic groups on the incidence of penile cancer, is discussed. Factors resulting in diagnostic delay and the stepwise development of penile cancer from a penile lesion to regional lymph nodes involvement and distant metastatic spread are described in the natural history section of the chapter. A critical review of the most significant currently available literature is presented.