Malignant lesions of the penis are uncommon and are essentially squamous cell carcinomas. In the United States, squamous cell carcinoma of the penis accounts for 0.4% of all cancers, and the incidence has remained stable over the last 25 years. It is more common in other populations, and in India, Africa, and South America, penile cancer accounts for 15% of all malignancies. The etiology of penile squamous cell carcinoma is the same as the etiology of malignant lesions in other parts of the body, i.e., due to chronic irritation. In particular, poor hygiene and circumcision are involved in the formation process of penile cancer, and chronic inflammation caused by debris in the foreskin may be the pathogenesis of malignant lesions. To support this theory, circumcision of newborns basically does not lead to this disease. In contrast, adults who are circumcised are not immune to this disease. In one study, 9% of patients with penile cancer were circumcised before developing cancer. Infection may also be the cause of this disease. Human papillomavirus DNA isolated from half of the penile cancer population has also been shown to be associated with other tumors. Not surprisingly, uncircumcision, circumcision, advanced age and recurrent STDs may all be risk factors for developing penile cancer. The incidence of the disease increases with age, with the average age of presentation being 60 years. However, patients have a wide age range of onset, with medical records documenting penile cancer patients in their teens. Morphologically characteristic lesions include exophytic and ulcerative. Exophytic lesions tend to be better differentiated, whereas ulcerative lesions are more common and have a poorer prognosis. Ulcerative lesions occur in 85% of cases and are often co-infected. Recurrent infections are characterized by the presence of secretions and reactive lymphadenopathy, typical lesions that prompt patients to seek medical attention. Importantly, the incidence of inflammatory lymphadenopathy is high, with 60% of patients presenting with palpable lymph nodes, but half of these biopsies prove to be lymphadenopathy. Early lesions are often small lumps or ulcers, most often confined to the penis. 50% of patients begin with lesions on the glans. This is followed by the prepuce, with lesions originating in the body of the penis accounting for the remainder. 60% of lesions are less than 2 cm at the time of presentation. The diagnosis of phimosis may be misdiagnosed until the appearance of pain, bleeding, discharge or obstruction. The importance of performing a tissue biopsy is not recognized because of the diversity of presentations at the time of presentation. High clinical vigilance is required for this condition. Biopsy should not be delayed when treated empirically as an infection or skin disease. The examination program should include a detailed history and physical examination. Note the lesions in the inguinal lymph nodes on palpation. Patients with ulcers that are co-infected or bleeding may have leukocytosis or anemia. Biopsies, cultures, and serology can help rule out other etiologies. Chest radiographs, bone scans, and CT of the abdomen and pelvis are helpful in assessing distant metastases in some selected cases. Buck’s fascia is an effective barrier of the penis against disease infiltration to the corpus cavernosum and secondary hematogenous dissemination. Only 2% of patients first have hematogenous dissemination without lymph node infiltration. The lungs are probably the most common site of metastasis, followed by bone, liver and brain. Lymph is the most common route of metastasis, beginning with metastasis to the femoral and iliac lymph nodes. Lymphatic fluid draining the penis exists in traffic with each other, so bilateral and contralateral lymph node lesions are common. Regional lymphadenopathy is often the cause of death in patients with penile cancer due to sepsis caused by ulceration or bleeding due to erosion of the femoral vessels by the cancer. Prognosis is associated with the presence of lymph node metastasis, tumor stage, tumor site, erosion of blood vessels, and loss of (ABO) blood group antigens. The status of the lymph nodes is the most important factor in predicting the prognosis of the disease and guiding the treatment of the patient. There are various staging methods, Jackson staging is the most commonly used: stage I: primary tumor is confined to the glans or prepuce, its prognosis is good; stage II, local infiltration to the penile corpus cavernosum without lymph node metastasis. 5-year survival rate for patients with stage I and II is 85%. stage III has clinical lymph node metastasis. stage IV tumor infiltrates beyond the penis to adjacent structures or distant metastasis occurs. The 5-year survival rate drops to 50% for patients with lymph node metastases; the survival rate is even lower for patients with distant metastases. The incidence of lymph node invasion or distant metastasis in patients with low grade is 15%, while the incidence of lymph node invasion or distant metastasis in patients with high or moderate grade is 40%-80%. The vast majority of patients with penile cancer die within 5 years of diagnosis. Treatment strategies rely on histological diagnosis and the extent of disease spread. The most basic aim of treatment is to preserve the functional and structural integrity of the organ, especially the ability to urinate directly. Patients with a confirmed diagnosis of carcinoma in situ can be treated locally with bleomycin or fluorouracil and closely followed up. ND-YAG laser can be used to treat limited lesions. For invasive cancer, radiation therapy and surgical excision are the main options. Surgical excision includes partial penile excision and total penile excision. Partial excision requires the cutting edge to be 2 cm from the tumor. Penile resection has a 10% risk of local recurrence. In patients with negative lymph nodes, 14% of patients usually become lymph node positive within 36 months. Local excision of glans and foreskin lesions has a 25% recurrence rate and requires careful follow-up in particular. Although penile cancer is primarily a surgical disease, radiation therapy can be used for limited low-grade lesions. Patients with selective lymph node negative penile cancer can have a 5-year survival rate of 70-80%. Radiation therapy is highly attractive because it avoids the need to remove the penis, but the risk of local recurrence is 3 times higher. For these patients, penile resection is almost always an effective remedial treatment. Remedial penectomy is also necessary in 15% of radiotherapy patients due to radiotherapy side effects such as urethral stricture or radionecrosis. Finally, a biopsy should be performed after treatment to confirm tumor eradication. Patients with clinically confirmed lymphadenopathy are treated with broad-spectrum antibiotics for 4-6 weeks first, as more than half of the palpable enlarged lymph nodes are reactive or inflammatory. Patients with cavernous, urethral, or vascular involvement of the penis, or highly graded tumors, are at risk for lymph node metastasis and should undergo prophylactic lymph node dissection. Patients with persistent lymph node enlargement should also undergo lymph node dissection. Classical lymph node dissection includes removal of lymph nodes from the lateral aspect of the suture muscle to the middle of the long end of the adductor muscle; and from 2 cm above the inguinal ligament to the lower part of the apex of the femoral triangle. A small number of patients may develop flap necrosis, brittle edema, and wound infection after surgery. The incidence of this complication can be further reduced by recommending a small excision without compromising survival. Effective treatment of systemic lesions is currently being explored. Fluorouracil, cisplatin and bleomycin are currently used most frequently.