Historically related to occupational exposure to soot in chimney sweeps.
Types:
- SCC
- Extramammary Paget’s disease
- Sarcoma
- BCC
- Melanoma
Risk factors:
- UV exposure – iatrogenic (psoriasis) phototherapy or sunlight
- HPV
- Occupational exposure – cutting oils, carcinogenic metals
- Chronic inflammation
- Smoking
- Poor hygiene
- Immunosuppression
Staging
T1 < 2 cm, T2 2 – 5 cm, T3 > 5 cm, T4 invading deeper dermal structure
N1 any node
Treatment:
- Surgical excision with clear margins +/- reconstruction as needed
- Inguinal lymph node examination and staging
- Scrotal drainage does not appear to cross midline – usually goes ipsilaterally
- Management of nodes somewhat extrapolated from penile cancer
- Consider SLNB for surgical staging, or ILND for palpable nodes
Reconstruction of scrotal wall
Depends on:
- Extent of defect
- Availability of healthy local tissue
Small defects can be managed with primary closure +/- secondary intention or granulation
Larger defects can be managed with VAC or local advancement flaps using either remaining scrotum or thigh tissue
Finally, fasciocutaneous thigh flaps, or meshed split thickness skin grafts can be used for big soft tissue defects.
Extramammary Paget’s disease
Rare intraepidermal adenocarcinoma – may be primary or secondary, can affect scrotum, penis and groin. Often in older men and initially treated for benign dermatological conditions like psoriasis.
Treat with surgical excision.