Penile cancer is known for its aggressive nature and propensity for loco-regional metastases. It is recognized by its stepwise regional spread to the inguinal and pelvic lymph nodes (LNs) before progressing to metastatic disease. Thus, the extent of lymphatic involvement remains the most important predictor of survival. Due to the rarity of the disease, high-level evidence in the management of the nodes is scarce, with treatment controversies and non-guideline care still prevalent in the United States (US).1