A man would generally notice a small lesion that developed on his penis and would seek medical care before the lesion developed into advanced penile cancer. If that man is severely overweight, his penis may not be visible, enveloped in fat pads.
“Buried penis represents a difficulty in early detection of suspicious lesions — but may also provide an environment susceptible to poor hygiene and subsequent chronic inflammation,” Timothy Byler, MD, writes in the September issue of Case Reports in Urology. He’s lead author of a paper with input from colleagues at Upstate Medical University, including Dmitriy Nikolavsky, MD, Srinivas Vourganti, MD, and Jared Manwaring.
They write about two cases of men in their 40s and 50s who may represent an enlarging demographic at risk. “Although HPV was found on one of the surgical specimens, these men represent young, nonsmokers who were circumcised as neonates and therefore should be at low risk for penile cancer,” Byler writes.
Both men had body mass indexes in the 50s. Each sought medical care for discharge from the area where his penis was contained. In both cases, doctors could not visualize the area without causing pain, so each man had to be examined under anesthesia. Biopsies revealed cancer. Both men chose to have their penises removed for treatment. One subsequently died from unrelated lung failure. The other was prescribed chemotherapy afterward.
Traditional risk factors for penile carcinoma include advanced age, lack of circumcision, smoking, HPV or HIV infection.
The urologists say they believe buried phallus may mimic lack of circumcision, because maintaining hygiene in the area is difficult, and the space provides an area for chronic inflammation and low grade infections. “This represents a new group of patients that must be carefully examined and counseled regarding penile carcinoma,” they write.