Penile cancer is a rare malignancy affecting only 1 per 100,000 men in North America and Western Europe. Although the majority of men present with clinically negative inguinal lymph nodes, node positivity is associated with a very poor prognosis. Both the management of positive nodes, and the management of clinically negative nodes in intermediate- and high-risk patients remain controversial. Experience with penile cancer is often limited as even tertiary referral cancer centers may see only one or two such patients per year. The literature, which consists mainly of retrospective studies of patients treated over several decades, is not conclusive. We undertook a literature review to address this issue and to propose a management scheme for our own benefit and that of others who face this scenario infrequently.