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Where Baker Mayfield goes from here, coming off a wrenching loss, can be tied to some clues from a quick look at how a dozen quarterbacks drafted within the top three picks in recent times fared in their rookie years. For now, Mayfield seeks to reach the Andrew Luck line.
It's harder to see in the wake of Sunday's 45-42 overtime loss in Oakland, but Baker Mayfield still has a chance for a satisfying rookie year.
Maybe the Browns will get ... Lucky?
Mayfield still has a chance to cause success the likes of which Andrew Luck inspired as a rookie No. 1 overall draft pick in Indianapolis.
Consider the fact Luck took some serious lumps before he and his team got their act together in his rookie year and went 11-5. Within Luck's first five games, he threw three interceptions in a blowout loss at Chicago and two picks to the Jets in a 35-9 defeat.
By rights, Luck should have dropped to 2-4 as a rookie with a home loss to the Browns. It was likely to happen if Josh Gordon hadn't dropped a late touchdown pass from Brandon Weeden. At that point, Luck had one of the worst passer ratings in the league. From there, he used the experience to lead the Colts on an 8-2 run.
Mayfield's radar was off Sunday. His ball security at key times was disturbing. Yet, the Browns scored more points than they had in any game since 2007. They would have scored more had he not been victimized by dropped passes, some of which should have been easy catches.
Let's see how he bounces back against Baltimore. Let's see if he can flirt with the kind of year Luck had as a rookie.
Consider an eerie parallel.
The 2012 Colts were coming off a 2-14 year, the upside of which was stumbling into a draft that featured Luck at the top.
The Colts were breaking in a fired Pittsburgh coordinator, Bruce Arians, to put the prized rookie on a fast track. Head Coach Chuck Pagano fell ill and was replaced by Arians in Game 5, from which point he and Luck went 9-3 the rest of the way.
The 2018 Browns, in turn, mined a No. 1 pick from the depths of 0-16. The choice was Mayfield, who wasn't supposed to be in Luck's class. His exemplary behavior since arriving, featuring a marvelous relief stint against the New York Jets, has inspired second opinions.
It turned out Mayfield was be making his first pro start in Game 4, later than Luck.
This may sound hauntingly familiar. Mayfield's offensive coordinator is in his first year with the team after getting fired by the Steelers. It's Todd Haley, who replaced Arians in Pittsburgh in 2012.
Browns fans are coming to know Mayfield as the type who imagines he can be better than a healthy Luck.
"I have had some great memories," last year's Heisman Trophy winner said after his rousing conquest of the Jets, "but I am just getting started."
Haley acknowledges the swashbuckler in Mayfield. He also notes that history is not full of lucky stars during rookie years.
"I have been around long enough to understand that there are going to be ups and downs," Haley said. "Without taking away that gunslinger attitude, we have to make sure he is doing smart things, not reckless or careless things. He did a couple in the Jets game and got away with them."
In the end. he didn't get away with them at Oakland.
Much is expected of Mayfield because of where he was drafted, but no more so than other QBs who have been selected way up there. Expectations generally didn't meet the desired results right away. See for yourself.
Here is a look at how QBs drafted in the top three overall this decade fared in their rookie years:
- Sam Darnold (No. 3, 2018, Jets) started right away, won his opener 48-17 at Detroit, but is 1-2 after getting outplayed by Mayfield in a 21-17 loss.
- Mitch Trubisky (No. 2, 2017, Bears) replaced Mike Glennon in Game 5 and posted a 4-8 record, with a 77.5 passer rating.
- Jared Goff (No. 1, 2016, Rams) replaced Case Keenum in Game 10. He went 0-7, ending with a 44-6 home loss to Arizona. His passer rating, 63.6, was plenty below the 92.3 put up by Cody Kessler, who went 0-8 as a rookie Round 3 pick in Cleveland.
- Carson Wentz (No. 2, 2016, Eagles) started opening day and won his first three games but was 4-9 the rest of the way. His passer rating was 79.3.
- Jameis Winston (No. 1, 2015, Bucs) started every game, was 5-5 at one point, but finished in a 1-5 slump. His season passer rating was 84.2.
- Marcus Mariota (No. 2, 2015, Titans) won an opening-day duel against Winston, 42-14, but lost 28-14 to Johnny Manziel at Cleveland a week later, wound up losing games to injuries, and went 3-9 with a 91.5 passer rating.
- Blake Bortles (No. 3, 2014, Jaguars) replaced Chad Henne during Game 3, then lost his debut as a starter 33-14 at San Diego in Game 4. He was 0-3 before getting a 24-6 win over the Browns. He wound up 3-10 with a 69.5 passer rating.
- Luck (No. 1, 2012, Colts) didn't have much of a passer rating (76.5; Mayfield's was 100.1 in his work against the Jets) but posted an 11-5 record. In the playoffs, he lost 24-9 at Baltimore.
- Robert Griffin III (No. 2, 2012, Redskins) was the opening-day starter and beat Drew Brees 40-32 at New Orleans. He then went into a 2-6 slump before winning his last six starts, interrupted by missing a game at Cleveland won by Kirk Cousins. He went 9-6 with a 102.4 passer rating in the regular season before losing at home in the playoffs, 24-14 to Seattle.
- Cam Newton (No. 1, 2011, Panthers) started from Day One and was 2-8 before finishing the year on a 4-2 hot streak. Overall, he was 6-10 with an 84.5 passer rating.
- Sam Bradford (No. 1, 2010, Rams) started every game, going 7-9 with a 76.5 passer rating with Pat Shurmur as his offensive coordinator. Shurmur was hired as head coach of the Browns in 2011.
Luck followed his 11-5 rookie year with two more 11-5 seasons before injuries derailed him. Griffin's rookie injuries contributed to him never approaching his early success. Newton became a league MVP. Wentz got a team in position for a Super Bowl in his second season. Goff helped his team reach the playoffs in Year 2 and has them 4-0 this season.
The long version of how some of these people fared after their rookie years is a story for another day.
Meanwhile, Mayfield has lost a groaner after winning a thriller. Maybe it will do him some good.
Reach Steve at 330-580-8347 or
On Twitter: @sdoerschukREP


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Sonakshi Sinha and Saiee Manjrekar were spotted wearing ethnic wear for the promotions of their upcoming movie, Dabangg 3. Dabangg 3 is set to release on 20th December this year and is a sequel in the Dabangg series. The movie is a Hindi language action comedy film which has been directed by Prabhudeva and is being produced by Salman Khan and Arbaaz Khan. This time, there is a newcomer in the movie, Saiee Manjrekar, who will play the role of the young Chulbul Pandey's love interest in the film. Saiee Manjrekar is the daughter of actor-director Mahesh Manjrekar. The promotions have started for the movie and the leading stars were recently seen on the sets of The Kapil Sharma Show. Check out the pictures here.
Sonakshi Sinha was seen wearing a printed sheer black saree with a black strappy blouse. Her hair was straight and sleek and she had left it open. The actor went for nude makeup for a natural look and accessorised her outfit with rings and earrings. Sonakshi's style has always been simple and chic.
Also Read | Dabangg 3 Song Yu Karke BTS: Salman Khan And Sonakshi Sinha Get Goofy; Watch Video
Also Read | Sonakshi Sinha's Best Saree Looks To Try This Wedding Season
Saiee Manjrekar was also seen at the promotions of the film. She was seen wearing a pale pista green lehenga and a golden embroidered off-shoulder blouse. She was carrying a georgette duppata with the outfit. To complete the look, the actor wore simple jewellery and makeup. She rounded up the look with soft curls and left it open. The actor posted some pictures of the outfit on her Instagram handle as well.
Saiee Manjrekar is a 21-year-old newcomer in Bollywood who is set to make her debut with Dabangg 3. The actor did not forget to give credits to her stylist, Ashley Rebello and her designer Seema Khan. Her hair and makeup were done by Mehak Oberoi.
Also Read | Saiee Manjrekar To Have A 'Dream' Debut With Salman Khan's Dabangg 3? Here Why
Also Read | Salman Khan And Saiee Manjrekar Know How To Pose For The Perfect 'rearview' Selfie
Get the latest entertainment news from India & around the world. Now follow your favourite television celebs and telly updates. Republic World is your one-stop destination for trending Bollywood news. Tune in today to stay updated with all the latest news and headlines from the world of entertainment.


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April 2018, Volume 48 Number 4 , p 32 - 39
A RARE DISEASE, cancer of the penis accounts for less than 1% of all malignancies in the United States and the Western World. About 80% of cases are diagnosed in men over age 55.1-3 Because of its rarity, most nurses and other healthcare professionals have never cared for a patient with cancer of the penis.
When diagnosed with penile cancer, a man is likely to experience fear about his mortality, sexual function, and masculine identity.4,5 This article will help the nurse understand the pathophysiology of cancer of the penis, treatment approaches, patient teaching, and psychosocial support. See Reviewing penile anatomy and physiology for background on normal penile function and structure.
Cancer of the penis, which most often begins in flat skin cells called squamous cells, can occur anywhere on the penis. Squamous cell carcinoma (SCC) accounts for approximately 95% of penile cancers.6
SCCs are most often associated with penile intraepithelial neoplasia (PeIN), a dysplastic process involving a new tumor. Human papillomavirus (HPV) infection, preexisting dermatoses, and lack of circumcision are among the risk factors that trigger development of PeIN.7-9 (See Risk factors for penile SCC.)
PeIN is diagnosed through a biopsy of the penile lesion. Histologically, PeIN lesions present with many variants, but most often have a wart-like, spiky, and/or a basaloid appearance, meaning that tissues look abnormal at the lowest level of the epidermis. PeIN is graded according to significance or severity. For example, Grade 1 is mild, Grade 2 is moderate, and Grade 3 is severe and termed high-grade PeIN or SCC in situ.7 This is considered by most researchers to be the earliest form of SCC.6,7
SCC in situ is confined to the epidermis and doesn't involve lymph nodes or other body organs.6,9 Lesions are further classified by the pathologist into differentiated and undifferentiated cells. Differentiated cells may look virtually normal with some immature cells that suggest early-stage malignancy. Undifferentiated cells, which are immature and lack normal tissue structure, are associated with advanced malignancy. Most PeIN lesions are differentiated.6,9
In SCC in situ of the penis, lesions may gradually undergo cell mutation, become malignant, invade surrounding tissues and internal structures of the penis, and enter the bloodstream and lymphatic system.6,7 Lymph nodes in the groin are usually the initial site to which the malignancy spreads, followed by a larger metastatic process involving intrapelvic lymph nodes. Metastases may also be found in the lungs, liver, bone, brain, and skin.9
A very rare type of SCC of the penis that isn't associated with PeIN is verrucous carcinoma, sometimes referred to as Buschke-Lowenstein tumor. This lesion looks like a large genital wart and can grow deep into penile tissues and structures, causing significant destruction. However, regional lymph node involvement and distant metastasis don't usually occur.1,10,11
About 5% of penile cancers are non-SCC.10 Changes in melanocytes on the penis can lead to melanoma, most often on the glans, followed by the foreskin and then the shaft and urethral meatus.1,6,10,11 These lesions are more common in older men than in younger men and have a high probability of metastasis if not treated early.
Sarcoma is a soft tissue malignancy that arises from changes in the cells of blood vessels, smooth muscles, and connective tissues. These lesions may metastasize.1,6,10,11
Changes in basal cells of the epidermis may lead to basal cell carcinoma of the penis, which has a low probability of metastasis.1,6,10,11
The pathologist will use the Tumor, Node, and Metastasis (TNM) Classification System to stage SCC and non-SCC penile lesions. This system stages or grades tumor size and characteristics, involvement of lymph nodes, and presence of metastasis. See Staging penile cancer for an abbreviated version of this system.12,13
The three types of SCC in situ are Erythroplasia of Queyrat (EQ), Bowen disease (BD), and Bowenoid papulosis (BP).1,14,15 EQ, BD, and BP have the same histologic features although they differ in location on the penis: EQ lesions are located on the glans and foreskin and BD and BP lesions are located on the shaft. Lesions aren't usually painful, although they may be slightly uncomfortable in the early stages.7
Because lesions may be very small, painless, and obscure, patients may not be alarmed and delay seeking treatment. When a man does seek treatment, lesions may be misdiagnosed as genital lichen sclerosus, a chronic inflammatory dermatosis of unknown origin, dermatitis, psoriasis, or condyloma (warts).2,7,10,16
EQ may initially manifest as an erythematous rash or irritation on the glans that's persistent and unresponsive to topical medications. Lesions are well defined and may be smooth, red, and velvety. (See Erythroplasia of Queyrat.) Some lesions may have a red to white appearance and may be pruritic. Over time, lesions may bleed and become crusty, scaly, ulcerated, and painful. An uncircumcised patient may have trouble retracting the foreskin. EQ becomes invasive SCC in 10% to 30% of cases.1,7,11
BD lesions are usually single, scaly, dull red plaques that may have areas of crusting. (See Bowen disease.) Lesions may be heavily pigmented and resemble melanoma. The differential diagnosis in BD includes BP, psoriasis, and superficial basal cell carcinoma. Invasive SCC occurs in 5% of BD cases.1,7
More common in younger men, BP lesions are typically multiple, slightly elevated, and red or violet in color. Although usually benign, BP can progress to invasive SCC. Infection with HPV 16 has been implicated in the development of BP.1,2,17,18
Signs and symptoms of BP and BD differ only slightly. BP may present with multiple lesions that look like small genital warts, whereas BD lesions are usually single and very isolated. BP is generally considered a benign dermatosis and may resolve spontaneously or progress to BD.
Both BP and BD are linked to HPV infection. Another distinction between BD and BP is that BP occurs more often in sexually active young men and in women who are exposed to HPV.1,2,7,10,14,17
Difficulty with urination and achieving an erection are common symptoms when noninvasive disease becomes a metastatic process because of tumor burden on the urethra, corpora cavernosa, and corpus spongiosum.17,19
Melanoma usually develops on areas of the body frequently exposed to the sun. When it develops on the penis, tumor thickness may be greater than it would be on other areas of the body. Like melanoma lesions found on other areas of the body, penile lesions can be brown, blue, black, raised, or flat, with asymmetrical borders. Subtle, asymmetrical changes in pigmentation on the penis should raise a red flag and be evaluated further.1,6,10,11
Sarcomas may present with a nonpainful lump anywhere on the penis. Basal cell carcinomas are usually raised and nodular, with a low probability of metastasis.1,6,10,11
When assessing a patient with a penile lesion, develop a trusting rapport during the health history interview and head-to-toe assessment. Be aware that he's likely to be anxious and/or depressed.
Include a social and sexual history in the interview. Some nurses are uncomfortable talking about issues related to sex. Approach this topic from a nonjudgmental perspective, with an understanding that people are sexual beings. To show compassion and offer reassurance, the nurse could say, "I imagine that the lesion on your penis has been frightening to you. I'm glad you're here to take care of it."
Questions that the nurse should ask during the health history interview include:
* When did you first notice the lesion on your penis?
* Is the lesion painful, itchy, or uncomfortable?
* Are you experiencing any other signs and symptoms; for example, are you having any difficulty urinating or achieving an erection?
* Does the lesion look the same all the time or does it change in size, shape, and color; for example, when you take a shower?
* How is your general health, appetite, and energy level?
* What medications are you taking?
* Do you smoke?
* Do you ever tan nude without covering your genitals?
* Are you now or have you ever been sexually active with men, women, or both?
* Have you and your partner or spouse talked about the lesion?
* Have you shared with your partner or spouse how concerning this is to you?
During the physical assessment, carefully inspect any lesions on the penis and surrounding tissues, and palpate the inguinal lymph nodes. Lab studies, including complete blood cell count, should also be performed to assess for systemic disease processes, infections, or inflammation.4,10,17,19 Additional data used to make a diagnosis include the pathology reports from a biopsy of penile lesions and lymph nodes, and imaging studies such as ultrasound, magnetic resonance imaging, and computed tomography.14,17
A histologic evaluation of the lesion and surrounding tissue should be performed as soon as possible from a biopsy specimen. Treatment approaches will depend on the location of the lesion on the penis and whether the carcinoma is invasive or noninvasive.1
The primary goal in managing cancer of the penis is to eliminate the malignancy while preserving a penis that is both functional and cosmetically acceptable to the patient. Excision of noninvasive lesions is recommended for lesions on the glans or shaft. This includes circumcision on the glans.
Removal of noninvasive lesions may require Mohs micrographic surgery.20 In this procedure, the surgeon slowly removes a layer of skin where the tumor is located. The tissue is examined under a microscope. The procedure is repeated until the skin samples are free from malignancy. The goal is to preserve as much uninvolved penile tissue as possible.1,21-23
Lesions may be treated with topical chemotherapy agents such as fluorouracil 5% cream that break down malignant cells while preserving normal skin. Some lesions may also be treated with cryotherapy, which causes cellular membrane dysregulation and cell death. Commonly used to treat genital warts and premalignant lesions of the penis, cryotherapy tends to cause blistering and is sometimes painful.17,19 Laser ablation is also an option for early-stage penile cancers.20
Patients with metastasis may require systemic chemotherapy for disease control and symptom management and to reduce disease activity so that the patient will benefit from lymph node dissection. Commonly used agents are methotrexate and cisplatin.20 Patients must be monitored for infection because the immune system is profoundly depressed during therapy. The nurse should monitor the patient's absolute neutrophil count to assess the degree of immunosuppression during therapy.
Systemic chemotherapy is often administered in combination with other therapies such as radiation.24 Radiation therapy may affect a man's ability to have an erection, damage surrounding tissue, and cause painful urethral strictures.25-27
Penile cancers have a proclivity for metastasizing to the inguinal lymph nodes. Lymph node involvement is the single greatest prognostic indicator of patient survival. The research evidence suggests that a radical lymphadenectomy (dissection) can arrest malignancy in patients with penile cancer who are at a high risk for metastasis.
Metastasis follows a predictable pattern from the primary penile tumor to the inguinal lymph nodes before spreading to the pelvic lymph nodes and then disseminating to the rest of the body. Although the surgical procedure is known to be curative in about 50% of patients, the potential for postoperative complications is considerable; these include wound infection, venous thromboembolism, and lymphedema, especially when the patient has comorbidities.28-30
Total glans resurfacing involves a dissection of epithelial layers of the glans for patients with noninvasive lesions. A partial-thickness graft is obtained from the thigh to replace the excised penile tissue. The procedure has demonstrated acceptable penile function and oncologic outcomes.21-23
A glansectomy may be performed for patients with some invasive disease. In this procedure, the glans is completely excised to the distal ends of the corpora. A urethral meatus is created using skin from the penile shaft. The patient will have an indwelling urinary catheter after the procedure to protect the urethra from damage. Patients must also rest for several days to allow the skin graft and remaining penile tissue to heal and should avoid sexual activity for 4 to 8 weeks. Oncologic outcomes are positive. The appearance and function of the newly reconstructed glans is usually acceptable to patients.1,21-23,31
Another penile preservation technique is a partial penectomy, or partial removal of the penis. Due to invasive disease, the entire glans and a portion of the shaft are removed. Grafts are used to replace excised tissue. Lymph node dissection may also be necessary. A surgical dressing is placed over the penis and an indwelling urinary catheter will be in place for several days. Patients must be monitored for edema and bleeding. After the urinary catheter is removed, the patient should support the groin during urination to avoid pressure on the surgical site. After partial penectomy, the man should be able to stand to void with a directed stream of urine and have satisfactory sexual function. He should avoid sexual activity for 4 to 8 weeks.1,21-23,31
Invasive carcinoma of the glans or shaft and even noninvasive forms of verrucous carcinoma of the glans (because of its destructive nature) may require total or radical penectomy (total amputation of the penis) if the patient's condition can't be managed with more conservative treatments. Lymph node dissection may also be necessary.20-23
The surgeon will perform a perineal urethrostomy and redirect the urethra to the area between the scrotum and rectum. After this procedure, the patient must sit to urinate and can't ejaculate.2,21-23 An indwelling urinary catheter will be in place for several days and the surgical site should be assessed for bleeding. The patient will be placed on stool softeners to prevent straining during bowel movements and stressing the surgical site.1,21-23,31
To address the profound changes in function, lifestyle, and body image, a patient undergoing total penectomy requires a multidisciplinary healthcare team comprised of nurses, including wound care specialists, the urologic surgeon, plastic surgeon, social worker, and counselor.4,5,22,23
A diagnosis of cancer of the penis is frightening. Patients will not only be worried about having a malignancy, they'll also be distressed by its effects on sexual intimacy and masculine identity.4,5,31 Research shows that most men want to keep their diagnosis a secret because they're embarrassed.5 Men are likely to experience a roller coaster of emotions from shock, denial, anger, and depression.5 Just the thought of losing the function of the penis is devastating.
Partial or total penectomy may adversely affect the quality of the patient's life, including his sexual functioning, problems with voiding, and the effect on a sexual partner of the absence of the penis or the appearance of residual penile issue. Research studies indicate that a man's ability to satisfy himself and his partner sexually with the penis are social expectations. Sexual rehabilitation is possible when the man is in a strong, supportive, and reassuring relationship. After total penectomy, a man can learn to experience sexual pleasure with touching or fondling and through manual stimulation of the scrotum, symphysis pubis, anus, and prostate.4
Patients are also concerned about the impact of penectomy on nonsexual intimacy and closeness with their partner and how their partner perceives them as a man and person.4,5,32,33 Even men who still have a fully functioning penis may fear that lesions will return and become invasive.
Although penile cancer is rare, men should be encouraged to perform regular self-exams of the penis. Teach patients to recognize characteristic signs and symptoms of cancer that should be evaluated by a healthcare provider (see Nursing assessment checklist). Also educate patients about genital hygiene and other measures they can take to reduce the risk of penile cancer.
For a patient undergoing treatment, education also includes the following:1,4,8,21-23,31
* Encourage the patient to get plenty of rest, eat a well-balanced diet, and remain active to maintain an optimal level of health.
* Teach the patient and his partner, if appropriate, about any prescribed medications, including topical medications and systemic chemotherapy if indicated. Because patients receiving systemic chemotherapy are prone to infection, tell the patient to report any illness, including a cold, sore throat, or fever, and to avoid people who are sick.
* If the patient underwent surgical excision of lesions and surrounding tissue, teach him to report unusual swelling, bleeding, problems voiding, or signs of infection at the incision site to the surgeon.
* After excision of lesions, teach the patient to support the scrotum and penis with an athletic supporter or small cloth placed under the scrotum placed in the man's underwear.
* Teach the patient and his partner proper urinary catheter care if he'll be discharged with the catheter in place.
* Encourage the patient to share his concerns and feelings. Open discussion can help him feel less isolated. Encourage the man's partner to share concerns and feelings as well. Refer them to resources such as support groups, counseling, and psychosexual therapy.
Men with carcinoma in situ are expected to live a normal life span, contingent on aggressive treatment and no recurrence of lesions. According to the American Cancer Society, men with Stage 1 or Stage 2 penile cancer have a 5-year survival rate of 85% with treatment. Men with Stage 3 or Stage 4 have a 5-year survival rate of 59% with treatment. However, the 5-year survival rate is 11% for men with penile cancer that has metastasized to other organs.34
The risk of cancer of the penis is mitigated by good genital hygiene, lifestyle modification, HPV vaccination, and circumcision. Comorbidities such as chronic illness tend to create additional challenges to prevention. Nurses and their healthcare colleagues need to have a strong knowledge base of cancer of the penis to care for and support men with this potentially life-altering condition.
The penis has three main functions:
* to serve as a passageway for urine from the bladder through the urethra
* to serve as a passageway for sperm for reproduction
* to provide sexual pleasure.
The top of the penis, called the glans, is the location of many sensitive nerves and the meatus from which urine flows via the urethra. A foreskin (prepuce) covers the glans in uncircumcised men.
The body or shaft of the penis contains two corpora cavernosa and one corpus spongiosum. These columns of tissue fill with blood to make erection possible.
Blood supply comes from the dorsal arteries of the penis, deep arteries of the penis, and bulbourethral artery, which are divisions of the internal pudendal artery and internal iliac artery. Nerves, muscles, ligaments, and lymphatics also help ensure proper functioning of the penis.
Approximately 80% of SCC in situ cases are related to HPV infection, especially HPV type 16 and HPV type 18, which carry a high risk for penile and cervical cancer. HPV type 16 and HPV type 18 are mainly transmitted through sexual activity.17,35,36 Other risk factors include the following:17,37
* lack of circumcision. Uncircumcised men are at an increased risk because the foreskin covers the glans where smegma, a sebaceous secretion, can accumulate and become a source of irritation to sensitive tissue. The foreskin may become taut in some men as they age, making it difficult to retract and trapping smegma. This condition is called phimosis.
* chronic irritation by urine, friction, and poor hygiene of the penis.
* cigarette smoking. Nicotine is a known carcinogen.
* exposure to UV light, especially when the genitals are exposed, can damage skin cells due to chronic inflammation.
* immunosuppression from disease processes and/or medications, which exposes the patient to opportunistic infections, including HPV and HIV.
* medical conditions of the penis such as genital warts, urinary tract infection, penile tears among men who were never circumcised, chronic penile rash lasting 1 month or longer, penile injury, and urethral stricture.
Erythroplasia of Queyrat (EQ) is SCC in situ of the glans.
This example of Bowen disease (BD) shows SCC in situ on the lower left shaft. The lesion is subtle, discrete, dull-red, and slightly raised.
When obtaining a health history or performing a physical assessment, check for:
* uncomfortable, irritating, or painful sensations from lesions or thickened skin anywhere on the penis. Patients may report that lesions become irritated during sexual activity. However, many penile lesions are asymptomatic.
* problems urinating or achieving an erection.
* irregular, blue, brown, red, dull-red, or velvety penile lesions, flat or raised. Penile lesions can appear anywhere on the penis, although the glans is the most common location.
* subtle skin changes on the penis. Ask patients if lesions look different at different times. For example, lesions may be more pronounced after showering or sweating. Changes in appearance over time is a strong indicator of serious pathology.
* thickened skin anywhere on the penis. The color of the thickened skin may blend well with the normal penile tissue.
* ulcerations or crusty lesions anywhere on the penis.
* bleeding or foul-smelling discharge from under the foreskin.
* inguinal lymphadenopathy.
1. American Cancer Society. Penile cancer. http://www.cancer.org/cancer/penile-cancer.html. [Context Link]
2. Nam JK, Lee DH, Park SW, et al Clinicopathologic characteristics and treatment outcomes of penile cancer. World J Mens Health. 2017;35(1):28-33. [Context Link]
3. Sharma P, Zargar-Shoshtari K, Pettaway CA, Schabath MB, Giuliano AR, Spiess PE. Disparities in penile cancer. Cancer Control. 2016;23(4):409-414. [Context Link]
4. Sosnowski R, Kulpa M, Kosowicz M, et al Quality of life in penile carcinoma patients-post-total penectomy. Cent European J Urol. 2016;69(2):204-211. [Context Link]
5. Gordon H, LoBiondo-Wood G, Malecha A. Penis cancer: the lived experience. Cancer Nurs. 2017;40(2):E30-E38. [Context Link]
6. Erbersdobler A. Pathologic evaluation and reporting of carcinoma of the penis. Clin Genitourin Cancer. 2017;15(2):192-195. [Context Link]
7. Zreik A, Ismail M, Nigam R. Penile intraepithelial neoplasia: management and outcomes. Human Androl. 2013;3(1):6-9. [Context Link]
8. Johnson C, Obanor N, DeWeese A. Human papillomavirus and cancer in men. Health Sci J. 2016;10(6):479. [Context Link]
9. Nicolas-Parraga S, Gandini C, Pimenoff VN, et al HPV16 variants distribution in invasive cancers of the cervix, vulva, vagina, penis, and anus. Cancer Med. 2016;5(10):2909-2919. [Context Link]
10. Minhas S, Manseck A, Watya S, Hegarty PK. Penile cancer-prevention and premalignant conditions. Urology. 2010;76(2 suppl 1):S24-S35. [Context Link]
11. Morris BJ, Krieger JN. Penile inflammatory skin disorders and the preventive role of circumcision. Int J Prev Med. 2017;8:32. [Context Link]
12. National Cancer Institute. Staging of penile cancer. http://www.cancer.gov/types/penile/patient/penile-treatment-pdq#section/_24. [Context Link]
13. Huether SE, McCance KL. Alterations in the male reproductive system. In: Understanding Pathophysiology. 6th ed. St. Louis, MO: Mosby-Elsevier; 2017:854-877. [Context Link]
14. Micall G. Urogenital squamous cell carcinoma. Medscape. 2017. http://emedicine.medscape.com/article/1102225-overview. [Context Link]
15. Marchionne E, Perez C, Hui A, Khachemoune A. Penile squamous cell carcinoma: a review of the literature and case report treated with Mohs micrographic surgery. An Bras Dermatol. 2017;92(1):95-99. [Context Link]
16. Pappas-Taffer LK. Lichen sclerosis. Medscape. 2017. https://emedicine.medscape.com/article/1123316-overview. [Context Link]
17. Fernandez MJ, Sanchez DF, Cubilla AL. Pathology, risk factors, and HPV in penile squamous cell carcinoma. In: Culkin DJ, ed. Management of Penile Cancer. New York, N.Y.: Springer; 2014:21-45. [Context Link]
18. Pettaway CA. Carcinoma of the penis: clinical presentation, diagnosis, and stages. UpToDate. 2017. http://www.uptodate.com. [Context Link]
19. Parker DC. Malignant dermatological diseases of the male genitalia. Medscape. 2017. http://emedicine.medscape.com/article/454810-overview. [Context Link]
20. Pettaway CA. Carcinoma of the penis: surgical and medical treatment. UpToDate. 2017. http://www.uptodate.com. [Context Link]
21. Li P, Song N, Yin C, et al Glans-preserving surgery for superficial penile cancer. J Androl. 2012;33(3):435-440. [Context Link]
22. Burnett AL. Penile preserving and reconstructive surgery in the management of penile cancer. Nat Rev Urol. 2016;13(5):249-257. [Context Link]
23. Zukiwskyj M, Daly P, Chung E. Penile cancer and phallus preservation strategies: a review of current literature. BJU Int. 2013;112(suppl 2):21-26. [Context Link]
24. Sharma P, Djajadiningrat R, Zargar-Shoshtari K, et al Adjuvant chemotherapy is associated with improved overall survival in pelvic node-positive penile cancer after lymph node dissection: a multi-institutional study. Urol Oncol. 2015;33(11):496.e17-496.e23. [Context Link]
25. American Cancer Society. Radiation therapy for penile cancer. http://www.cancer.org/cancer/penile-cancer/treating/radiation-therapy.html. [Context Link]
26. Van Poppel H, Watkin NA, Osanto S, Moonen L, Horwich A, Kataja V. Penile cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(suppl 6):vi115-vi124.
27. Crook J. Radiation therapy for cancer of the penis. Urol Clin North Am. 2010;37(3):435-443. [Context Link]
28. O'Brien JS, Perera M, Manning T, et al Penile cancer: contemporary lymph node management. J Urol. 2017;197(6):1387-1395. [Context Link]
29. Koifman L, Hampl D, Koifman N, Vides AJ, Ornellas AA. Radical open inguinal lymphadenectomy for penile carcinoma: surgical technique, early complications and late outcomes. J Urol. 2013;190(6):2086-2092.
30. Ovejero-Gomez VJ, Martin-Cuesta L, Martinez-Bretones F, et al Inguinal lymphadenectomy assessment associated with penile carcinoma undergone new strategies for nodal staging. Case Rep Clin Med. 2014;3(7):410-415. [Context Link]
31. Turner B, Drudge-Coates L, Henderson S. Penile cancer: diagnosis, clinical features and management. Nurs Stand. 2013;27(29):50-57. [Context Link]
32. Branney P, Witty K, Braybrook D, Bullen K, White A, Eardley I. Mortality and sexuality after diagnosis of penile cancer: a participative study. Int J Urol Nurs. 2016;10(3):137-145. [Context Link]
33. Sansalone S, Silvani M, Leonardi R, Vespasiani G, Iacovelli V. Sexual outcomes after partial penectomy for penile cancer: results from a multi-institutional study. Asian J Androl. 2017;19(1):57-61. [Context Link]
34. American Cancer Society. Penile cancer survival rates. http://www.cancer.org/cancer/penile-cancer/detection-diagnosis-staging/survival-. [Context Link]
35. Centers for Disease Control and Prevention. Prevalence of HPV in adults aged 18-69: United States, 2011-2014. http://www.cdc.gov/nchs/products/databriefs/db280.htm. [Context Link]
36. de Martel C, Plummer M, Vignat J, Franceschi S. Worldwide burden of cancer attributable to HPV by site, country and HPV type. Int J Cancer. 2017;141(4):664-670. [Context Link]
37. Pettaway CA. Carcinoma of the penis: epidemiology, risk factors, and pathology. UpToDate. 2017. http://www.uptodate.com. [Context Link]
38. Giuliano F. Neurophysiology of erection and ejaculation. J Sex Med. 2011;8(suppl 4):310-315. [Context Link]
39. Huether SE, McCance KL. Male reproductive system. In: Understanding Pathophysiology. 6th ed. St. Louis, MO: Mosby-Elsevier; 2017:793-798. [Context Link]
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14 Jan
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Showing 1-3 of 3
By: Don Breckon
Price: £20.00
Publisher: UK, David & Charles: 1991
Edition: 1st Edition
Sellers ID: 03060
Condition: Very Good
Don Breckon's superb paintings recreate the golden days of steam, when little branch lines and sleepy stations connected country communities with towns and cities near and far. This book will appeal to railway enthusiasts and country lovers alike. There is light creasing to the base of the spine on the rear of the D/W View more info
By: Don Breckon
Price: £18.00
Publisher: UK, David & Charles: 1987
Edition: 2nd Edition
Sellers ID: 03884
Condition: Near Fine
It's all here: the shapely majesty of the locomotives of the Big Four, with emphasis on the Great Western, set landscapes of Constable calmness'; the stations, accurate in every evocative period detail; the hidden rituals of the engine shed; the porters, signalmen and passengers who were privileged to play their part in this glorious panorama. The top front corner of the D/W shows light wear. A good, clean and tight copy. View more info
By: Don Breckon
Price: £20.00
Publisher: UK, David & Charles: 1989
Edition: 3rd Edition
Sellers ID: 03885
Condition: Near Fine
With many paintings that have not been seen before, Don Breckon concentrates on his favourite subject, the Great Western Railway - the artist's railway its variety, precision and neatness, the railway that enhanced the countryside through which it ran. The D/W shows light marking and shelf wear. A good, and tight copy. View more info


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Reversal by Michael Connelly Get Books from Amazon
Reversal by Michael Connelly: Connelly's new thriller features two of his series heroes-the wily defense attorney Mickey Haller and his half-brother, LAPD detective Harry Bosch. This time Haller is working the other side of the courtroom, as a special independent prosecutor trying to keep a very nasty child molester and killer behind bars, with Bosch doing his legwork.
But Haller isn't defending…he is the Prosecuter! He brings along his ex-wife on this adventure as well.
This was a brilliant court room drama with plenty suspense and twists and turns. Haller is called on to put a convicted felon back behind bars after his conviction is overturned on a technicality. Although he is not used to prosecuting he does his job well.
A must read for sure…
Other books by Michael Connelly
Showing 1 – 10 of 206 results for "Michael Connelly" in Kindle Store.
The Drop (Harry Bosch) by Michael Connelly
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The Harry Bosch Novels: The Black Echo, The Black Ice, The Concrete Blonde by Michael Connelly
1 2 3 4 5 6 7 8 9 10 … Next > >


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If you plan to purchase a fixer-upper or renovate your existing home, an FHA 203 (k) loan may be the perfect loan for you. FHA 203(k) loans are backed by the.
Fha Loan Pros And Cons But we had never used an FHA loan before — only conventional mortgages. This time around, we ended up using an FHA home loan to buy the house. The down payment was the biggest draw for us. We spoke to several mortgage folks about the pros and cons of conventional versus FHA loans. Here's what we learned along the way: The FHA Home Loan
One way for financing a fixer upper is to take out a home equity line of credit (HELOC). Of course, you want to be very careful and ensure that you plan to stay in your home a long while before doing so. Or, you could find yourself upside down on your mortgages.
This loan allows a home buyer to purchase a fixer-upper home and finance all repairs with a single, permanent loan. It can be used for existing homeowners who want to refinance and make repairs, too. Benefits of the New Freddie Mac Loan.
One solution is to broaden the search to fixer-uppers. With a renovation mortgage , you can get one home loan that combines the purchase.
This article is reprinted by permission from NerdWallet. It's the lament of first-time home buyers in just about every housing market: There aren't enough entry-level homes available that are move-in.
Popular TV shows about house fixers and flippers have sparked consumer interest in remodeling, creating an opportunity for lenders to build a specialty in renovation loans while traditional mortgage.
Fha Construction Loan Guidelines What Is A Fha 203B Loan fha 203k loans are designed to help borrowers finance an older home that needs significant repairs. To get an FHA 203k loan, you must work with an FHA-approved lender. You will also have to provide a detailed proposal of the work you want to do.Last week hud issued Mortgagee Letter 2009-16 which provides guidance on changes to manufactured housing requirements. the Federal Manufactured Construction and Safety Standards and is so labeled..
Many foreclosed homes are damaged and qualify for HUD loans for fixer-upper homes Homes that have been foreclosed are often damaged.
Va Home Remodeling Loans American Home Lending USA | Mortgage Loan Products – Do you need to tap into your home's equity to pay for a home remodeling.. When compared to all other 100% financing home loans, VA Home Loans are the.
Compare home loan rates. dear darryl, The real estate agent is correct about conventional financing if the home can't qualify for a certificate of occupancy.
Consider a loan with a built-in reserve. The Federal Housing Administration (FHA) 203(k) rehabilitation loan or Fannie Mae HomeStyle Renovation Mortgage could be good financing options for buyers seeking fixer-uppers. These loans allow you to purchase the home with a reserve that's put in escrow to fund renovations.
How to finance a fixer-upper By: Amy Fontinelle, July 03rd 2019. Tweet; Tweet; If you're buying a home that needs a little TLC, a typical fixed-rate mortgage isn't going to help you pay for repairs. Your lender isn't going to approve a $300,000 loan to buy a home that's only worth $250,000. And, while homeowners sometimes use home equity loans.
let you borrow money to buy a home and fix it up. And you may begin renovations right after closing the loan. renovation loans give you more homebuying options by making it possible to buy.


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Roadrunner Families,
It is hard to believe that it is already time for our yearly Kinder Round-Up! Next Tuesday, April 2nd we will be welcoming new families as well as some familiar faces for our annual introduction to Russell Lee Elementary School and kindergarten information session. The event will kick off at 9:00 am in our cafeteria and then conclude at 10:30 following a presentation of our Kindergarten Dinosaur Program by our current kindergarteners. Please help us spread the word to any new Roadrunner Families. There will be a performance of the Kindergarten Dinosaur Program for the entire school on Tuesday evening at 6:30.
I want to share the joyous arrival of Rudolfo Marcus Margarito Franco to our 2nd grade teacher, Chrystine Osborn and her husband, Chris Franco. He was born on Wednesday, March 20th, weighed six pounds, three ounces and was just over twenty inches long. Congratulations to Chrystine and Chris and welcome to the Lee Family, Rudolfo! Ms. Osborn will be out for the remainder of the year and we are fortunate to have Ms. Evie Peña-Shives subbing for her. She comes to us with a wealth of experience teaching at multiple grade levels in Austin and Chicago, where she taught at the Walt Disney Magnet School. She has been subbing for our 2nd grade teachers to get to know the students and we are very excited to have her at Lee.
There will be no school on Friday April 19th as our teachers participate in important professional development. We will be utilizing some of that time to further analyze data on student performance in the lead up to the end of the year and STAAR testing at the upper grade levels. Earlier this semester, each grade-level team spent an entire day reviewing student data on reading and math levels as well as performance on benchmark tests. That data review day was used to chart the course for our work with students through the remainder of the year.
Lastly, I wanted to let let you know that Delano Howard has accepted the Head Custodian position at Davis Elementary. We greatly appreciate all that Delano has done for our students, staff and school. Under his leadership our custodial evaluations have improved and we have successfully weathered a number of facilities challenges. Please join us all in wishing him all the best in the next chapter in his career.
Have a wonderful weekend,
John Hewlett
Principal – Russell Lee Elementary School


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Tag: Sterling Pierce
Top 10 Moments of Villanova Athletics in 2016
With 2016 coming to a close, we'll take this time to look back and celebrate the top moments of the year in Villanova Athletics. While Wildcat alumni Kyle Lowry and Matt Szczur each received championship fanfare, they are not included within this list. Lowry, who was a point guard for Team USA basketball, won a gold medal at… Read More ›
Week In Review: Road Trippin' (Week of 11/30)
Every single Villanova team left campus this past weekend to hit the road. Can't blame them for it though, especially with finals just around the corner. Here are the top stories from this past week: Holy War: Villanova played its first Big Five opponent of the season, heading over to Hagan Arena to play St… Read More ›


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