title: Initial symptoms and delay in patients with penile carcinoma.
abstract: OBJECTIVE
  This study aimed to assess initial symptoms and factors associated with patients' and doctors' delay in penile carcinoma.
  
  
  METHODS
  Fifty consecutive patients with penile carcinoma treated with an organ-sparing technique and nine with partial amputation were enrolled in a prospective study at the Department of Urology, Örebro University Hospital, between 2005 and 2009. Face-to-face structured interviews in combination with self-assessment forms were used for the patients' descriptions of clinical symptoms, treatment seeking and reasons for delay. Data were also extracted from the medical records confirming time-lag between GP assessment, specialist care and time for diagnosis.
  
  
  RESULTS
  Erythema, rash and eczema were the most common initial symptoms (35%). In total, 65% had a patients' delay of more than 6 months, and among these there was a small, but not statistically significant, predominance for pT1 and pTis tumours. Living with a stable partner did not affect the delay. The most common reason for patients' delay was the feeling of embarrassment over symptoms localized in a sexual body area. Nine patients had a doctors' delay of more than 3 months from first special visit to diagnosis. Eight of these patients consulted dermatologists and were subjected to repeated biopsies, leaving premalignant results.
  
  
  CONCLUSIONS
  A considerable proportion of the patients had a patients' delay of more than 6 months, perhaps due to benign initial symptoms as erythema, rash or eczema. Psychological factors such as embarrassment and denial may also be involved, as well as insufficient awareness or knowledge.
authors.affiliation: Department of Urology, Örebro University Hospital, Örebro, Sweden. elisabet.skeppner@orebroll.se
authors.forename: Elisabet
authors.initials: E
authors.lastname: Skeppner
authors.forename: Swen-Olof
authors.initials: SO
authors.lastname: Andersson
authors.forename: Jan-Erik
authors.initials: JE
authors.lastname: Johansson
authors.forename: Torgny
authors.initials: T
authors.lastname: Windahl
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D057210:Delayed Diagnosis / Q000523:psychology; D004485:Eczema / Q000175:diagnosis / Q000209:etiology; D004890:Erythema / Q000175:diagnosis / Q000209:etiology; D005076:Exanthema / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology; D010412:Penile Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012883:Skin Ulcer / Q000175:diagnosis / Q000209:etiology; D013997:Time Factors