Penile Cancer Facts: How Penile Cancer Starts, Where It Grows, and the Types You May Hear About

If you or someone you love was just told they may have penile cancer, you probably have a lot of questions. This guide covers the basic penile cancer facts in plain language: what the penis is made of, how cancer gets started there, where it usually begins, and the different types doctors look for under the microscope.

Penile cancer is rare. The American Cancer Society estimates about 2,260 new penile cancers and about 450 deaths in the United States in 2026. Fewer than 1 in 100,000 men in the United States are diagnosed each year, and penile cancer makes up fewer than 1% of all cancers. The average age at diagnosis is about 60. Because it is uncommon, many men have never heard of it, and many primary care doctors see only a case or two in a whole career.

What Is the Penis?

The penis is an organ that does two jobs. It carries urine out of the body, and it carries semen during sex. It is built from skin, nerves, blood vessels, smooth muscle, and connective tissue (the fibrous material that holds body parts together).

The long part of the penis is called the shaft. The rounded tip is called the glans, sometimes called the head. At birth, the glans is covered by a sleeve of loose skin called the foreskin, also called the prepuce. In some men, the foreskin is removed in infancy or later in an operation called circumcision.

Inside the penis are three columns of spongy erectile tissue (tissue with blood vessels that fill with blood to create an erection). The two on the upper sides are the corpora cavernosa, and they form most of the bulk of the penis. The single column running underneath is the corpus spongiosum, and it widens at the end to form the glans. All three are wrapped in connective tissue and covered by skin.

The urethra is the thin tube that carries urine from the bladder and semen out of the body. It runs inside the corpus spongiosum and opens at the tip of the glans through a small hole called the meatus. Because the urethra sits inside the penis, a tumor that grows deep can eventually press on it.

Lymph nodes (small glands that filter fluid and help fight infection) sit in the groin on both sides, just below the crease where the leg meets the body. These are called the inguinal lymph nodes. Lymph fluid drains out of the glans and the shaft and flows into these groin nodes first. That single fact explains much of how penile cancer is staged and treated.

(Source: National Cancer Institute)

How Does Penile Cancer Start?

Healthy cells follow a schedule. They grow, they copy their DNA (the instruction manual inside every cell), they divide into two new cells, and then they stop or die when they are no longer needed. Special genes act like brakes and repair crews, fixing mistakes in the DNA before a cell is allowed to divide again.

Cancer starts when enough of those instructions get damaged that a cell ignores the stop signals. It keeps dividing when it should rest, it refuses to die on schedule, and it starts to crowd out normal tissue. The National Cancer Institute describes penile cancer as the result of changes in how penile cells grow and divide. Most of these changes are not inherited from your parents. They build up in the skin cells of the penis over many years.

Two forces do most of that damage in penile cancer. The first is human papillomavirus, or HPV, a very common virus passed through skin-to-skin sexual contact. There are more than 200 types of HPV. About 12 are called high-risk types because they can cause cancer, and HPV 16 and HPV 18 cause most cancers linked to the virus. When a high-risk HPV infection does not clear on its own and stays for many years, the virus interferes with how infected cells copy themselves and divide. Over time, those cells can multiply out of control.

The second force is chronic inflammation. Inflammation is normally a short repair process: injured tissue releases chemicals, white blood cells arrive, new cells grow to patch the damage, and then the process shuts down. In chronic inflammation, the shutoff switch never flips. The National Cancer Institute notes that inflammation that keeps going can damage DNA and lead to cancer. On the penis, long stretches of irritation under a tight foreskin, repeated infections, or a scarring skin condition can keep that damaging cycle running for years. Tobacco chemicals add to the damage from the inside.

Because of these two routes, doctors now describe penile squamous cell carcinoma as having two pathways: one that is driven by HPV, and one that is not driven by HPV and is instead tied to chronic irritation and scarring. The two pathways often show different gene changes inside the tumor, which is why your pathology report may mention HPV testing or a marker called p16.

Cancer almost never appears overnight. In most cases, the skin first goes through precancer changes, where cells look abnormal under a microscope but have not yet broken through the thin boundary layer called the basement membrane. Doctors call this penile intraepithelial neoplasia. This stage matters enormously, because precancer changes can usually be treated with creams or minor surgery before they ever become invasive cancer. That is why any patch, sore, or color change on the penis that lasts more than a few weeks deserves a look from a clinician.

Where Does Penile Cancer Start?

Penile cancer usually begins in the skin surface. The most common starting places are the glans and the inner surface of the foreskin, with the coronal sulcus close behind. Penile cancer usually forms on or under the foreskin, and the American Cancer Society notes that most of these cancers start on the foreskin in men who have not been circumcised, or on the glans.

Numbers from United States cancer registries back this up, with one caveat. In a review of penile squamous cell cancers in the United States, 34.5% of tumors were recorded on the glans, 13.2% on the prepuce (the foreskin), 5.3% on the shaft, and 4.5% overlapped more than one area. The caveat is that 42.5% were recorded as unspecified, so the true share on the glans and foreskin is almost certainly higher than the raw percentages suggest.

The shaft is an uncommon starting point. When cancer is found on the shaft, it more often arrived there by spreading sideways from the glans or foreskin than by starting there. Cancer can also begin at the opening of the urethra, though this is rare.

There is a reason the glans and inner foreskin are the hot spots. Both are lined with thin, moist skin that never forms a tough outer layer, and HPV infects that kind of skin easily. Both also sit in a warm, enclosed space where secretions, moisture, and irritants can collect, especially if the foreskin cannot be pulled back for cleaning. The combination of an easy target for the virus and a place where irritation lingers is exactly the setup described in the previous section.

Where a tumor starts determines how your care team can treat it. Small cancers limited to the glans or foreskin can often be treated with creams, laser, Mohs surgery, circumcision, or removal of just the surface of the glans, keeping as much of the penis and its function as possible. That is one more practical reason early detection is worth so much.

If you want a fuller picture of what to look for, our companion guide on penile cancer symptoms walks through the sores, lumps, color changes, discharge, and bleeding that most often bring men in.

How Does Penile Cancer Affect the Body?

Penile cancer usually starts as a small, painless lesion, nodule, lump, or ulcer. Because it rarely hurts at first, and because early tumors often do not affect erections or urination, it is easy to dismiss. Many men are given creams or antibiotics for what looks like an infection before anyone considers cancer. If a spot is not clearly better after a short course of treatment, ask for a biopsy.

Left alone, the tumor spreads sideways across the skin surface first. It may cover much of the glans or foreskin before it starts pushing downward into the erectile tissue and the shaft. Once it grows deep, it can begin to affect function. A tumor near the meatus can narrow the opening and make the urine stream weak, split, or slow. A tumor that invades the erectile tissue or the nerves can affect erections.

The next step for the cancer is the lymph system. Lymph fluid from the glans and shaft drains first into the superficial inguinal lymph nodes in the groin, then into the deep inguinal nodes, then into the pelvic nodes, and only later to nodes farther up in the abdomen. Penile cancer follows this route in order, which is why your doctor will carefully feel both groins and may order an ultrasound, CT, MRI, or PET scan, and may recommend a sentinel lymph node biopsy or lymph node dissection.

Spreading to distant organs is uncommon early on. A tough layer of connective tissue called Buck fascia acts as a barrier, and only about 1% to 10% of men have distant spread when they are first seen. When it does happen, the usual sites are bone, liver, lung, or brain, and there is almost always groin node involvement as well.

Here is the encouraging part, and it is not a small one. The extent of groin lymph node involvement is the single most important predictor of long-term survival, and most men do not have it at diagnosis. The American Cancer Society has estimated overall five-year survival for penile cancer in the United States at about 65%. For cancers still confined to the penis at diagnosis, five-year survival after surgery has been reported at up to 85%, and men with no groin node spread have reported five-year survival in the range of 85% to 100%. Early treatment is often successful. You can read more in our guides on penile cancer stages, penile cancer treatment, and penile cancer survival rates.

Types of Penile Cancer

Your pathology report will name a type and often a subtype. This is not just labeling. The subtype helps predict how fast a tumor grows, how likely it is to reach the lymph nodes, and how likely HPV is involved.

Squamous cell carcinoma accounts for over 95% of penile cancers. It begins in the flat, thin squamous cells that make up the skin surface of the glans, foreskin, and shaft. Within that big group, pathologists recognize several subtypes, with the reported shares below drawn from published series:

• Usual type squamous cell carcinoma: This is the standard form and the most common, making up roughly 45% to 65% of penile squamous cell carcinomas. Under the microscope, it shows keratin production and typical cancer features. It tends to grow slowly and is often curable when found early.

• Papillary carcinoma: This subtype grows outward in finger-like projections and accounts for roughly 2% to 15% of cases. It is usually well differentiated, meaning the cells still look fairly organized, and it tends to behave less aggressively.

• Warty (condylomatous) carcinoma: This subtype makes up roughly 7% to 10% of cases and can look a lot like a large genital wart. It is one of the subtypes most strongly tied to HPV, especially HPV 16.

• Basaloid carcinoma: This subtype accounts for roughly 4% to 10% of cases. It is also strongly tied to HPV 16, and it tends to be more aggressive than the usual type, with a higher chance of reaching the groin lymph nodes.

• Verrucous carcinoma: This uncommon subtype makes up roughly 3% to 7% of cases. It looks like a large wart and can grow quite big and push into nearby tissue, but it very rarely spreads to distant parts of the body.

• Sarcomatoid (spindle cell) carcinoma: This is the least common subtype at roughly 1% to 6% of cases, and it is the most aggressive. The cells take on a stretched, spindle shape, and this pattern carries a higher risk of spread.

• Carcinoma in situ: This is squamous cell cancer confined to the top layers of skin, with no invasion into deeper tissue. It is also called stage 0is (or stage 0) and, in current pathology language, penile intraepithelial neoplasia. It is the most treatable stage of all.

A small number of penile cancers are not squamous cell carcinoma at all. These are far less common, but they are treated differently, so an accurate diagnosis matters:

• Melanoma: Only a very small share of penile cancers are melanomas, which begin in the pigment-producing cells of the skin. Melanoma is usually found on skin exposed to the sun, so a melanoma on the penis is unusual. It tends to behave more aggressively than squamous cell carcinoma.

• Basal cell carcinoma: This makes up only a small portion of penile cancers. Basal cell carcinoma grows slowly and rarely spreads to other parts of the body, so the outlook is generally good.

• Adenocarcinoma, also called Paget disease of the penis: This very rare type develops from sweat glands in the skin of the penis. Under a microscope, it can be hard to tell apart from carcinoma in situ, so specialized pathology review is helpful.

• Sarcoma: A small number of penile cancers are sarcomas, which begin in blood vessels, smooth muscle, or other connective tissue rather than in skin cells. Kaposi sarcoma can also involve the penis, most often in men with a weakened immune system.

If your report uses a word you do not recognize, ask for it in writing and ask what it means for your treatment options. Our guide on questions to ask about penile cancer includes wording you can borrow at your next appointment.

Related Conditions to Penile Cancer

Many skin conditions on the penis are not cancer. Some are true precancer, meaning abnormal cells are already present and treatment can stop the process. Others are benign lookalikes, meaning they are harmless in themselves even though they can resemble cancer or, in a few cases, keep the skin irritated in ways that raise risk. Only a biopsy can tell them apart with certainty.

Precancerous conditions include the following:

• Penile intraepithelial neoplasia (PeIN): This is the current umbrella term for precancer of the penile skin, where the cells look abnormal but have not broken through the basement membrane. All of these lesions are now considered high-grade, and about 2% will progress to squamous cell carcinoma if they are not treated. This term now covers what used to be called Bowen disease, erythroplasia of Queyrat, and squamous cell carcinoma in situ of the penis.

• Carcinoma in situ: This is the same idea described from the staging side. Cancer cells are present only in the top layers of skin. It is called stage 0is and it is highly treatable.

• Erythroplasia of Queyrat: This is the older name for carcinoma in situ appearing on the glans or foreskin. It usually looks like a well-defined red, velvety patch. It is precancer, not a benign rash.

• Bowen disease: This is the older name for carcinoma in situ appearing on the shaft or other genital skin. Like erythroplasia of Queyrat, it is precancer and is treated.

• Bowenoid papulosis: This condition is linked to HPV and tends to occur in younger, sexually active men. It appears as small red, brown, or purple spots or patches, most often on the shaft. Under a microscope, it resembles carcinoma in situ, but it usually behaves in a benign way and may even clear on its own within a few months. Dermatologists therefore classify it separately. If it does not clear and is not treated, it can rarely progress to squamous cell cancer.

Benign conditions that can raise risk or can be mistaken for cancer include the following:

• Lichen sclerosus, also called balanitis xerotica obliterans: This is a chronic skin condition that shows up as flat white patches on the glans and foreskin. It is often silent, but it can cause burning, itching, or painful erections, and over time it can scar the foreskin and the urethral opening. It is not cancer, but it is associated with penile intraepithelial neoplasia and with squamous cell carcinoma that is not driven by HPV. Symptomatic cases are usually treated with topical steroid creams, and ongoing follow-up is reasonable.

• Condyloma acuminatum, also called genital warts: These growths look like very small cauliflowers and are caused by certain HPV types. They can grow to an inch or more if untreated. The HPV types that cause most genital warts are low-risk types 6 and 11, which are different from the high-risk types linked to cancer. Even so, men who have had genital warts have a somewhat higher risk of penile cancer, likely because warts are a marker of HPV exposure in general.

• Phimosis: This is a foreskin that is too tight to pull back over the glans. It is common in childhood and usually resolves, but in adults it makes it hard to clean underneath, which can lead to lasting irritation and inflammation. Adults with longstanding phimosis have a higher risk of penile cancer. Reported increases in risk fall in the range of 25% to 60%. Phimosis is treatable, and treating it is worthwhile for comfort and hygiene as well as risk.

• Balanitis and balanoposthitis: Balanitis is inflammation of the glans, and balanoposthitis involves the glans and the foreskin together. It causes redness, soreness, itching, and sometimes discharge. Yeast, bacteria, soaps, and skin conditions can all cause it. It is very common, it is treatable, and by itself it is not cancer. It matters here for two reasons: repeated episodes keep inflammation going, and a stubborn case that does not clear with treatment can turn out to be cancer in disguise.

• Other benign lookalikes: Genital psoriasis, genital lichen planus, and sexually transmitted infections such as herpes and syphilis can all produce patches or sores on the penis. Pseudoepitheliomatous keratotic and micaceous balanitis is a very rare thick, warty, whitish plaque on the glans that has been reported to progress to verrucous carcinoma.

What Are the Genetic and Risk Factors?

Penile cancer is not considered a strongly hereditary cancer. There is no well-established inherited gene that runs in families and causes it, and there is no genetic test that tells a man he will develop it. The gene changes that matter in penile cancer happen inside the penile skin cells during a man's lifetime and are not passed to children.

Human papillomavirus (HPV) is the leading risk factor. Estimates of how many penile cancers are caused by HPV vary; it is between 60% to 63%.

Other factors that have been linked to higher risk include the following:

• Phimosis and chronic inflammation: A foreskin too tight to retract makes cleaning difficult and keeps the skin irritated. Longstanding phimosis in adults is one of the strongest risk factors, with reported risk increases of 25% to 60%.

• Lichen sclerosus (balanitis xerotica obliterans): This chronic scarring skin condition is associated with penile intraepithelial neoplasia and with squamous cell carcinoma arising without HPV.

• Smoking and other tobacco use: Men who smoke or use other tobacco products are more likely to develop penile cancer. Researchers believe tobacco chemicals damage genes in penile cells. Along with high-risk HPV and phimosis, smoking is considered one of the three strongest risk factors.

• HIV infection and other immunosuppression: Men living with HIV have a higher risk, reported in one review as roughly eight times higher. Men who take medicines to protect a transplanted kidney have also been reported to have a much higher risk than the general population. A weakened immune system has a harder time clearing HPV and controlling abnormal cells.

• PUVA therapy for psoriasis: PUVA combines a drug called a psoralen with ultraviolet A light. Men treated this way have been found to have a higher rate of penile cancer, and the long-term risk reported in follow-up studies is very high and appears to rise with the number of treatments, even when the genitals were shielded. If you have had PUVA, mention it to your dermatologist and urologist.

• Older age: Risk rises steadily with age. In the United States, the average age at diagnosis is about 60.

• Circumcision status and hygiene: Men who were not circumcised as newborns have a higher reported risk, mainly because an intact foreskin makes HPV infection and chronic irritation more likely. Poor genital hygiene and many sexual partners are also listed as risk factors. None of this is a moral judgment, and the absolute risk for any individual man remains very low.

• Access to care and geography: Higher rates are reported in areas of lower socioeconomic status. In parts of Africa, Asia, and South America, where circumcision is less common, and HPV and HIV are more prevalent, penile cancer can account for 1% to 2% of all cancers in men, which is several times the rate seen in the United States and Europe.

What Are the Related Cancers to Penile Cancer?

Penile cancer belongs to a family of cancers caused by the same virus. HPV causes six types of cancer: anal, cervical, oropharyngeal (the middle part of the throat behind the mouth), penile, vaginal, and vulvar. The CDC reports that HPV causes about 39,300 cancers each year in the United States.

The share attributed to HPV differs by site; 63% of penile cancers are attributed to it. Because these cancers share a cause, a man diagnosed with an HPV-related penile cancer may also be at higher risk of anal or oropharyngeal cancer, and there is documented evidence of HPV affecting more than one site in the same person, especially when the immune system is weakened.

(Source: National Cancer Institute)

The shared cause also matters for partners. HPV passes through intimate skin-to-skin contact, so partners may share exposure to the same virus types. That does not mean a partner will develop cancer, and it does not mean anyone gave anyone cancer. It does mean that partners benefit from staying current on cervical cancer screening and from HPV vaccination where it applies. Cervical cancer is currently the only cancer caused by HPV that has an approved screening test, so for the others the practical step is reporting unusual symptoms promptly.

Some risk factors also raise the risk of cancers outside the HPV family. PUVA therapy has been associated with a higher rate of squamous cell skin cancer generally, including on skin that was not directly exposed. Men on medicines that suppress the immune system after a transplant, and men living with HIV, have raised rates of a number of skin cancers and other cancers as well. If either applies to you, regular full skin examinations are worth discussing with a dermatologist.

Smoking connects penile cancer to a much wider group of cancers, including lung, bladder, kidney, head and neck, and others. Quitting helps on many fronts at once, and it may also reduce the chance that an existing high-grade precancer progresses. Every state has a quitline staffed by counselors trained to help, reachable at 1-800-QUIT-NOW.

Every man's situation is different. Use these facts as a starting point for the conversation, then work through the specifics with your own care team. If you would like to talk with others who understand, see our guides on penile cancer support and joining a clinical trial for penile cancer.

Whatever your results show, the next step is a conversation with your own care team about what the findings mean for you and what you want to do next.

Sources:

• Penile Cancer, Patient Version, National Cancer Institute

• What Is Penile Cancer?, National Cancer Institute

• Penile Cancer Diagnosis and Prognosis, National Cancer Institute

• HPV and Cancer, National Cancer Institute

• Risk Factors: Chronic Inflammation, National Cancer Institute

• Risk Factors: Immunosuppression, National Cancer Institute

• What Is Penile Cancer?, American Cancer Society

• Risk Factors for Penile Cancer, American Cancer Society