Ans. C: Hypospadias is a premalignant lesion Following as risk factors for penile cancer: Human papillomavirus (HPV) infection, smoking, smegma, phimosis, treatment of psoriasis, age, and AIDS. The other etiologic factor most commonly associated with penile carcinoma is poor hygiene. Lichen sclerosus (also known as balanitis xerotica obliterans) may also be a risk factor. Symptoms Redness, irritation and a sore or a lump on the penis. Pathology Precancerous Dermatologic Lesions Carcinoma in Situ (Bowen Disease, Erythroplasia of Queyrat) Invasive Carcinoma of the Penis A Squamous cell carcinoma usually originating in the glans or foreskin is by far the most common type, occurring in 9 out of 10 cases. Staging The stages are assessed as follows: Stage I - Cancer has only affected the glans and/or foreskin. Stage II - Cancer has spread to the shaft of the penis. Stage III - Cancer has affected the penis and surrounding lymph nodes. Stage IV - Cancer has moved beyond the groin area to other pas of the body. Recurrent - Cancer that has returned after treatment. The most common treatment is one of five types of surgery: Wide local excision - The tumor and some surrounding healthy tissue are removed Microsurgery - Surgery performed with a microscope is used to remove the tumor and as little healthy tissue as possible Laser surgery - laser light is used to burn or cut away cancerous cells Circumcision - cancerous foreskin is removed Amputation (penectomy) - a paial or total removal of the penis, and possibly the associated lymph nodes. This is the most common and effective treatment. Radiation therapy is usually used adjuvantly with surgery to reduce the risk of recurrence. With earlier stages of penile cancer, a combination of topical chemotherapy and less invasive surgery may be used. More advanced stages of penile cancer usually require a combination of surgery, radiation and chemotherapy.