Inguinal Lymph Node Management in Penile Cancer

Authored by Asif Muneer, published on 2026-11-03 23:10:11.0

  1. Inguinal LNs
    • Clinical Stage Assessment
      • Impalpable LNs (cN0)
        • Low Risk (Tis, Ta, T1a)
          • Surveillance
        • Intermediate Risk (T1a G2)
          • T1a G2
            • DSNB
              • Superficial Modified ILND and Frozen Section (If DSNB Is Unavailable)
                • Radical ILND (L/R)
                  • 0-1 Positive LNs
                    • Surveillance
                  • ≥2 Positive LNs, ENE, or Metastasis Diameter >30 mm
                    • PLND
                      • Adjuvant Chemotherapy or Postoperative RT
                        • Surveillance
                • Surveillance
              • Surveillance
            • Surveillance
          • T1b G2
            • DSNB
              • Superficial Modified ILND and Frozen Section (If DSNB Is Unavailable)
                • Radical ILND (L/R)
                  • 0-1 Positive LNs
                    • Surveillance
                  • ≥2 Positive LNs, ENE, or Metastasis Diameter >30 mm
                    • PLND
                      • Adjuvant Chemotherapy or Postoperative RT
                        • Surveillance
                • Surveillance
              • Surveillance
        • High Risk (T1b or Higher)
          • Superficial Modified ILND and Frozen Section (If DSNB Is Unavailable)
            • Radical ILND (L/R)
              • 0-1 Positive LNs
                • Surveillance
              • ≥2 Positive LNs, ENE, or Metastasis Diameter >30 mm
                • PLND
                  • Adjuvant Chemotherapy or Postoperative RT
                    • Surveillance
            • Surveillance
      • Palpable LNs (cN1–2)
        • Fine-Needle Biopsy
          • Excisional Biopsy
            • Radical ILND (L/R)
              • 0-1 Positive LNs
                • Surveillance
              • ≥2 Positive LNs, ENE, or Metastasis Diameter >30 mm
                • PLND
                  • Adjuvant Chemotherapy or Postoperative RT
                    • Surveillance
            • Surveillance
          • Radical ILND (L/R)
            • 0-1 Positive LNs
              • Surveillance
            • ≥2 Positive LNs, ENE, or Metastasis Diameter >30 mm
              • PLND
                • Adjuvant Chemotherapy or Postoperative RT
                  • Surveillance
      • Ulcerated or Fixed LNs (cN3)
        • Radical ILND (L/R)
          • 0-1 Positive LNs
            • Surveillance
          • ≥2 Positive LNs, ENE, or Metastasis Diameter >30 mm
            • PLND
              • Adjuvant Chemotherapy or Postoperative RT
                • Surveillance
        • Neoadjuvant chemotherapy or RT with concurrent chemotherapy
          • Stable or Clinical Response
            • Consolidation Surgery
              • Surveillance
          • Disease progression or non-resectable
            • Chemotherapy or RT for local control; Clinical trial
              • Surveillance
tosprivacyPenile cancer: ESMO–EURACAN Clinical Practice Guideline for diagnosis, treatment and follow-up