Penile cancer is an uncommon malignancy that has a devastating effect on the patient while also being challenging to diagnose and treat. By implementing preventive measures, we can decrease the incidence of this disease and improve the quality of life of our patients. Early detection plays an important role in disease control and proper diagnostic modalities must be used in order to accurately identify the cancer and its progression. Primary penile lesions should be initially approached when surgically feasible and clinically appropriate with penile preserving surgical techniques. Advances in inguinal lymph node detection and management, has improved the clinical outcome of penile cancer. Advanced penile cancer still portends a poor prognosis and should be approached via a multimodal treatment regimen. In this review, we address the importance of prevention, early detection, and the contemporary management of primary penile lesions, as well as the advances in inguinal lymph node disease detection and surgical treatment, for both localized and advanced disease. 1. Introduction Penile cancer is an uncommon disease in the US and Europe that has a devastating effect on the patient while also being challenging to diagnose and treat. A distinction between benign and malignant penile neoplasms must be made in order to offer the most effective treatment . In 2010, the new cases of penile cancer in the United States are about 1,250 with 310 deaths, with an incidence rate of 0.3 to 1.8 per 100,000 [2, 3]. Penile cancer is much more common in African, Asian, and South American countries, constituting about 10% of malignant disease in these countries and thus posing a considerable health concern [1, 4]. Notably, Paraguay and Uganda have an incidence rate of 4.2 and 4.4 per 100,000, respectively . The lowest incidence is found in Israeli Jews (0.1/100,000) . Cancer of the penis most commonly affects men between the ages of 50–70, with only 19% at ages <40 and 7% <30 . Squamous cell carcinoma of the penis was found to be 43% greater in men from countries where the poverty level is >20% . 2. Risk Factors The presence of an intact foreskin has been identified as an important risk factor for developing penile cancer. Maden et al.  found that the risk of penile cancer was 3.2-times greater among men who had never been circumcised relative to men circumcised at birth and 3.0-times greater among men circumcised after the neonatal period [3, 5]. In addition, penile cancer is rarely seen in Jews, as they are circumcised at birth . A history of phimosis
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