A 75-year-old widower with a history of depression was admitted because of an 8-week history of genital bleeding. He lived alone; he had no history of major medical or surgical conditions, and was being treated with antidepressants since his wife died about 5 years earlier. The physical examination revealed the absence of penis with minimal bleeding from the penile stump (Fig. 1). Three years earlier, the patient had noticed the occurence of an ulcerative lesion at the root of the penis, which had widened and had led to a spontaneous amputation of the organ. Due to shame, he had not revealed this event even to his doctor. A total body computed tomography showed pathological lymph nodes in the groin and extensive hepatic metastases. The patient underwent biopsy of the penile ulcer and the histological examination confirmed the diagnosis of a spinocellular epithelioma.

Fig. 1
figure 1

The image showed amputation of the penis with minimal bleeding from the penile stump

Full size image

Penile cancer develops as a painless process, and its most common presentation is ulcer over the glans or prepuce, rarely it occurs on the penile shaft [1], but its diffusion until the self-amputation is a rare occurence both because it is noticed early on by the patient, and because of the presence of an anatomical barrier constituted by the Buck’s fascia that prevents a rapid dissemination. Surgery, radiotherapy and chemotherapy lead to a survival of around 52% at 5 years, but, in untreated patients, it decreases to 6% [2, 3]. In our case, chemo or radiotherapy was not indicated due to extensive metastases of the liver, so palliative care was given, but the patient died a few weeks after the formal diagnosis was made.