To determine the long-term outcome of men with carcinoma of the penis with clinically negative lymph nodes undergoing a modification of the standard inguinal lymphadenectomy. The study included nine men (mean age 56.2 years, range 41-72) with squamous cell carcinoma of the penis who underwent a modified inguinal lymphadenectomy. Of the nine patients, three had histologically positive lymph nodes; none of the patients with positive or negative nodes had evidence of recurrent disease. All patients were alive within a follow-up of 13-108 months (mean 67.5). Early post-operative complications occurred in two patients with skin-flap necrosis, one with prolonged lymphatic drainage and one with a delayed groin lymphocele and cellulitis. The modified inguinal lymphadenectomy is a reasonable alternative to surveillance and may accurately identify men with positive nodes. Long-term survival and low morbidity seem to justify this approach in men with squamous cell carcinoma of the penis and clinically negative inguinal lymph nodes.