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Penile malignancies are infrequent but represent a diagnostic and therapeutic challenge as patients tend to disregard early asymptomatic lesions of the disease. Due to the lack of studies involving large patient numbers, the therapeutic concepts for different stages of the disease could not be defined by prospective studies. Long-term results are rare. We present the therapeutic concepts and the 10-year results of our experience with 42 cases of penile carcinoma treated at our institution between 1973 and 1986. Therapy included radical circumcision in 10 cases, local excision of the tumor in 4, partial or total glandular resection in 6 patients, partial penectomy in 20, and total penectomy in 2 cases. Inguinal lymphadenectomy was performed initially in 14 cases with positive histology in 7 patients (50%). Complications included meatal stenosis in 8 cases (19%), urethral stricture in 1 case, death due to fulminant pulmonary embolism in 1 case and local infections in 2 cases. Follow-up of patients with initially nonmetastatic disease showed a progression to death in 4 of 35 patients (11.6%) with a mean survival of 30 (range 11.5-56) months, in patients with initial lymph node metastases progression to death occurred in 5 of 7 patients (71.4%) with a mean survival of 9.76 months (range 9 days to 24 months). Stage-related disease-specific 10-year survival rates are 100% for stages 0 and 1, 90.9% for stage 2, and 20% for stage 3, while no patient in stage 4 survived for 5 years. From our data we conclude that the single most important prognostic factor in the treatment of carcinoma of the penis is lymph node involvement. Therefore increased attention has to be paid to the recognition of early stages of this potentially curable disease.