Introdution
Penile cancer is a relatively rare neoplasm in the developed world and 95% of the cases histologically correspond to squamous cell carcinoma (SCC)(1). Although it accounts for 10%– 20% of all malignancies in males in Asia, Africa, and South America, it has a prevalence of only 1% in Western countries (2). In the United States and Europe, SCC of the penis accounts for 0.4 to 0.7% of all malignancies found in men; the incidence varies from 0.1 to 0.7 per 100,000 population (1).
Several etiologic risk factors have been recognized in the development of this malignancy. Infection with oncogenic types of Human Papilloma Virus (HPV) and lichen sclerosus seem to be the main risk factors for this neoplasm, but also, lack of neonatal circumcision (especially when associated with phimosis), and exposure to tobacco, among other causes, have been implicated (3).
We describe an interesting case of a squamous cell carcinoma of the penis in a 67-year-old patient with a 9-months history of tumor growth associated with phimosis , for which total penectomy, perineal urethrostomy and bilateral inguinal lymphadenectomy were carried out.

Case report
A 67-year-old man with a 9-months history of penile tumor growth associated with surface ulceration attended the our Hospital. The presence of phimosis was observed in the previous month during urological examination. The patient denied any hematuria and urinary symptoms. Physical examination indicated the presence of a solid swelling at the level of the distal portion of the penis associated with foul smelling purulent ulceration involving the skin nearby (Fig.1). Examination of the urethra, scrotum and testes were normal.
Several movable inguinal lymph nodes of 1.0–1.5 cm in size with moderate consistency could be palpated on both sides. The results of laboratory examinations were normal except for leucocytosis. He had full genital screening but the tests were negative for gonorrhoea, chlamydia, mycoplasma, ureaplasma and Trichomonas vaginalis. Subpreputial swab taken for candida was also negative.
Antibiotics had been administered for 2 weeks, without improvements.
In agreement with the urologist, the patient underwent to ultrasound exam of the penis that showed a solid inhomogeneus mass involving the corpora cavernosa associated to thickening of the tunica albuginea (Fig. 2). The Color-Doppler US reveled an incresed arterial vascularization of the solid lesion (Fig.3a) and, partly, of the corpora cavernosa (Fig.3b).