Carcinoma of the penis is a rare but aggressive malignancy, with lymphatic metastasis being the most significant prognostic factor. Accurate staging of inguinal lymph nodes is crucial for treatment planning and survival outcomes. Traditional inguinal lymphadenectomy, while effective, is associated with high morbidity, including lymphedema, wound infections, and skin necrosis. Sentinel lymph node biopsy (SLNB) has emerged as a minimally invasive technique to identify nodal metastases in clinically node-negative (cN0) patients, potentially reducing unnecessary lymphadenectomy while maintaining oncological safety. This video displays the role, accuracy, and clinical impact of SLNB in penile cancer management.

This video includes a review of SLNB technique performed on a cN0 patient with carcinoma penis. The procedure involves introperative lymphoscintigraphy with Fluorescein and Methylene blue, intraoperative identification of sentinel lymph nodes using Ultraviolet light/Blue light, and selective excision of the identified nodes. The histopathological evaluation of sentinel nodes, was performed to detect micrometastases. The video presentation demonstrates injection techniques, intraoperative lymphatic mapping, and biopsy retrieval.

SLNB has shown high sensitivity and negative predictive value in detecting micrometastases in cN0 patients. Patients with negative sentinel nodes are able to avoid unnecessary inguinal lymphadenectomy, significantly reducing postoperative complications. The false-negative rate remains a concern, but it has been minimized with refinements such as the use of dual tracers and intraoperative frozen section analysis. Comparative analysis with modified lymphadenectomy suggests that SLNB provides comparable oncological outcomes with significantly lower morbidity.

Sentinel lymph node biopsy is a valuable tool in the management of carcinoma penis, allowing for accurate lymphatic staging with minimal morbidity. While false negatives remain a challenge, advancements in technique and adjunct diagnostic tools have improved its reliability. SLNB offers a promising alternative to routine lymphadenectomy, reducing complications while ensuring adequate oncological control. Further prospective studies and standardization of protocols are required to optimize its clinical application.