I was recently diagnosed with SCC on the glans of my penis.  I had what I thought was a mole for about 18 months that started to scab up and wouldn’t go away.  After my dermatologist took a biopsy, it was confirmed SCC and it was removed with the Mohs procedure.

I’ve read that HPV can be the cause of this cancer about 25-30% of time.  I’m 41 now and am single.

Would it make sense for me to get the HPV vaccine now to reduce my chances of getting another infection that could possibly lead to cancer again?

Also, not sure if this falls in the scope of what you can help with.  But, when cancer is present.  Does it usually just show up in one spot?  I’m concerned that my entire glans is involved due to the dry skin that I’m experiencing there.  I’m deathly afraid of the nuclear option (penectomy) and was wondering what your experience has shown you.

Thank you

I'm curious if this is the same penile lesion you described in your first thread on our forum, a little over a year ago. And second, I would assume the inflammation diagnosed as a fungal infection is unrelated to your penile cancer.

My understanding is that HPV causes more like 50% of squamous cell carcinoma (SCC) of the penis, rather than 25-30%. Probably the pathology report either on the biopsy already done, or on the tumor that has been removed, will tell if HPV is involved in your case -- but I don't think this makes any important difference in your management, except maybe in regard to vaccination (discussed below).

Now we get into issues beyond my expertise. I'm glad to hear your SCC is being managed with the Mohs procedure, which (I believe) implies a limited tumor that is not likely to require a more radical procedure like penectomy. My recollection is that penectomy is rarely needed for cure, and almost entirely in long-neglected cancers that have been growing for several years. And SCC of the skin rarely is metastatic, i.e. uncommonly spreads to distant body sites, and thus almost always is cured by local surgery, as long as the excision goes beyond the margin of the tumor as determined by microscopic examination. (This is the principle behind the Mohs procedure as I understand it.) As best I know, all this applies equally to SCC of the penis as for anywhere else on the body; and to my knowledge the cases caused by HPV are neither more nor less likely to behave in these ways. Finally, in response to your closing question, I believe SCC of the penis usually occurs in only one spot. It would not surprise me if having it once raises the risk of a subsequent cancer. I suspect it happens in a minority of cases, but I have no knowledge of the statistics on this.

HPV vaccination is worth considering, it seems to me. I just did a quick search of the medical literature and find no reports on whether vaccination has any effect on either local recurrence or development of new penile SCC. Originally the vaccine was believed to protect only against new HPV infections, but recent research has shown a modest reduction in reactivation of previously acquired infection. Logically, that might mean lower risk of future recurrence of SCC, but no data are available. But immunization is harmless, and HPV vaccine is now approved up to age 45, so the cost likely would be covered by your health insurance. Therefore my attitude is "Why not?". But maybe not if your tumor is found to be HPV negative.

All these questions definitely need to be discussed with your dermatologist. But I hope my limited understanding is somewhat helpful. Let me know if anything isn't clear.

HHH, MD

Im wondering as well if what was going on a year ago was related to this.  But, no diagnostic test was ever done and the lesion resolved on its own.  So, I am not sure if there’s a connection.

After reading your response, I believe I will move forward with the vaccine and hope it provides some benefit for possible future infections.  Though even if it doesn’t, I know it’s harmless to try.

The mohs procedure was done with clear margins that was confirmed before the site was sutured up.  So, I’m confident it was cleared in that one spot.

I have another dermatologist appointment to discuss my concerns about other areas of my glans.  But, hoping it can be managed with less invasive techniques if it looks to be of concern.

This is extremely rare as I have found out through my research.  So, your insight is very helpful to me as I navigate this diagnosis and recovery.  I appreciate it very much.  It has been difficult to find information that is comparable to what I am experiencing.

Hoping I can put this behind me and resume my normal life soon.

Thanks again!

If your current SCC is at exactly the same spot as the lesion you asked about 16 months ago, presumably it is reappearance of the previous one. If elsewhere, it is new since then.

Indeed penile SCC is rare. The American Cancer Society (cancer.org) says about 2,000 cases per year in the US -- a very small number in a population of 330 million.

Thanks for the thanks. I'm glad to have helped.

I was thinking that maybe it was the beginning phase of what’s currently going on.  But, that seems unlikely now that I think about it.  Going to keep an eye on where I had mohs and hopefully heal up and move on.

One last question about the vaccine.  My understanding is that multiple variations of HPV can lead to cancer.  So, I’m assuming that the type that led to cancer for me, the vaccine will not be able to do anything about.  But, the types that are not associated with my current cancer.  I could be protected through vaccination against those right?  Or could I have multiple strains causing my current issue?  Either way, I plan on getting vaccinated.  Just was a question that popped in my head overnight.

That’s all the questions I have.  Appreciate your help with this.  

Thanks for the thanks. I'm glad to have helped.