Penile Lesion Grown for the past 2 years

75 yo M with large fungating penile mass has been present for years but patient has previously declined treatment or evaluation went to the clinic today for worsening constipation and pain. His clinic evaluation yielded Na 120 which per provider is new with prior values being normal and no medications changes to account for derangement, worsening anemia Hb 7.1 (prior stable at 10), WBC 13.4.

Patient notes that he ignored the penile lesion as it grew over the past two years because he did not want the family take focus off his daughter battling breast cancer. He reports no change in his ability to urinate. He also reports that he was able to defecate after getting a stool softener at the clinic. Denies chest pain, HA, nausea, vomiting, SOB, lightheadedness.

Any insight would be appreciated. Thank you

Dec 8, 2024 by Kristine Pasco, DNP, MPH, APRN, FNP-BC

2 replies

Eugene Worth
MD, M.Ed., FABA, ABPM/UHM

I'm no dermatologist, but that's a squamous cell carcinoma until proven otherwise.

Do not pass GO ... Do not collect $200 ... biopsy this mass and go from there.

Just my thoughts.

Other experts, please chime in ...

Dec 8, 2024

Craig Lindsey
MD

There is another possibility that could be explored and may tie the low sodium together with the penile lesion. Although a somewhat rare occurrence, nephropathies may occur in the secondary stages of syphilis and lead to hyponatremia. Ulcers associated with primary syphilis (chancre) are painless in a relative sense and this would be a good differentiating question in the history. Other STI's can also cause ulcers but these are often painful. Agree with Dr. Worth's comments about biopsy, but secondary syphilis and resultant hyponatremia could explain the other presenting problems.

This one should have some interesting follow up...

Dec 8, 2024

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