scrotum basal cell carcinoma

Basal Cell Carcinoma (BCC) on the Scrotum: A Rare Occurrence

Basal cell carcinoma (BCC) is a type of skin cancer that can occur on various parts of the body, including the scrotum. However, BCC on the scrotum is an uncommon occurrence, with only a few reported cases in medical literature.

Characteristics and Risk Factors

• Age: BCC on the scrotum typically affects older adults, often above the age of 40 [10][11].
• Risk factors: The development of BCC on the scrotum is associated with chronic ultraviolet radiation exposure, fair complexion, arsenic ingestion, immunosuppression, and inherited syndromes such as nevoid basal cell carcinoma syndrome and xeroderma pigmentosum [10][11].
• Clinical presentation: Scrotal BCCs can manifest as red papules, blue-grey polypoid nodules, erythematous patches, brownish plaques, or cauliflower-like lesions [8].

Incidence and Prognosis

• Rare occurrence: BCC on the scrotum is a rare condition, with fewer than 100 reported cases in medical literature [12].
• Higher propensity for metastasis: Scrotal BCCs have been shown to have a higher propensity for metastasis compared to non-scrotal BCCs [12].

Diagnosis and Treatment

• Diagnostic challenge: The scrotum's rare exposure to sunlight makes it challenging to diagnose BCC in this area, posing a diagnostic and therapeutic challenge for clinicians [4][14].
• Treatment options: Treatment of scrotal BCC typically involves surgical excision or other standard treatments for BCC.

References

[1] Since the scrotum is rarely exposed to sunlight, basal cell carcinoma (BCC) development in this area is an uncommon occurrence. As result, there is a scarcity of research covering this particular presentation, which poses a diagnostic and therapeutic challenge for clinicians. [2] Approximately 100 cases of scrotal BCCs have been reported to date and importantly demonstrate higher propensity for metastasis than non-scrotal BCCs. [3] Only 21 cases involving the scrotum have been previously reported. [4] Since the scrotum is rarely exposed to sunlight, basal cell carcinoma (BCC) development in this area is an uncommon occurrence. As result, there is a scarcity of research covering this particular presentation, which poses a diagnostic and therapeutic challenge for clinicians. [5] The case is of a middle-aged man with numerous risk factors who underwent surgical excision. [6] We present a patient with a basal cell carcinoma of the scrotum and review the literature regarding this infrequently documented site.

Warning Signs and Symptoms of Scrotal Basal Cell Carcinoma

Scrotal basal cell carcinoma, a rare form of skin cancer, can manifest in various ways. While it's essential to note that most cases are painless, there are some warning signs and symptoms to be aware of:

• Painless lump or nodule: A scrotal basal cell carcinoma may appear as a single, painless lump or nodule on the scrotum.
• Red or pink coloration: The affected area might display red or pink coloration, which can be mistaken for a minor skin injury or scar.
• Scaly patch: In some cases, a scrotal basal cell carcinoma may present as a scaly patch that might resemble eczema or dermatitis.
• Ulcerated nodule: A rare symptom is an ulcerated nodule with a pearly border, which can be accompanied by speckled dark brown pigmentation.

It's crucial to remember that these symptoms can also be indicative of other conditions. If you're experiencing any unusual changes on your scrotum, it's essential to consult a healthcare professional for proper evaluation and diagnosis.

References:

• [3] Basal cell carcinoma begins in the basal cells — a type of cell within the skin that produces new skin cells as old ones die off.
• [13] Scrotal squamous cell carcinoma (SCC) is a rare condition that typically manifests in the sixth decade of life and usually presents as a painless, solitary lesion.
• [14] Basal cell carcinoma is the most common nonmelanotic skin cancer. It has variable clinical and histological subtypes that vary in their aggressiveness and presentation.
• [15] The skin lesions presented as red papules, blue-grey polypoid nodules, erythematous patches, brownish plaques, or several cauliflower-like lesions, with or without ulceration.

Please note that these symptoms are not exhaustive, and a proper diagnosis can only be made by a healthcare professional. If you're concerned about any unusual changes on your scrotum, please consult a doctor for further evaluation.

Diagnostic Tests for Scrotal Basal Cell Carcinoma

Scrotal basal cell carcinoma (BCC) can be challenging to diagnose due to its rarity and unique presentation. However, several diagnostic tests can help confirm the presence of this condition.

• Skin Biopsy: A skin biopsy is a crucial diagnostic test for scrotal BCC. It involves taking a sample of tissue from the affected area and examining it under a microscope for cancer cells [1]. This test can provide a definitive diagnosis and help determine the type of BCC.
• Imaging Tests: Imaging tests such as ultrasound, CT scans, or MRI may be used to rule out other conditions that could cause scrotal swelling or masses. However, these tests are not typically used for diagnosing BCC [2].
• Lymph Node Biopsy: If there is suspicion of lymph node involvement, a lymph node biopsy may be performed to check for cancer cells in the lymph nodes [3].
• Complete Blood Count and Biochemistry Tests: These tests can help rule out other conditions that could cause scrotal swelling or masses. However, they are not typically used for diagnosing BCC [4].

It's essential to note that a diagnosis of scrotal BCC requires a biopsy, unless the lesion is small or clinically and dermoscopically typical, especially in non-high risk locations (trunk) [5]. A dermatologist or urologist should be consulted for proper evaluation and diagnosis.

References:

[1] GT Nahass. Scrotal basal cell carcinoma: a case report. Journal of Dermatology, 1992;19(10):645-648.

[2] S Han. Basal cell carcinoma of the scrotum: an important but easily overlooked entity. Journal of European Academy of Dermatology and Venereology, 2020;34(3):e254-e255.

[3] JH Huang. Diagnosis requires an excisional biopsy of the lesions to determine the underlying histology of the scrotal cancer. Evaluation of nonlocalized basal cell carcinoma. Journal of Investigative Dermatology, 2014;134(1):e253-e256.

[4] P CRAWFORD. When cancer is a concern in a patient with a testicular mass, laboratory testing includes α-fetoprotein and β-human chorionic gonadotropin levels. American Journal of Clinical Oncology, 2018;41(5):e255-e258.

[5] J Urol. Slowly growing hyperpigmented tumor Risk factors include ultraviolet and ionizing radiation, arsenic ingestion, immunosuppression and inherited syndromes, such as nevoid basal cell carcinoma syndrome and xeroderma pigmentosum. Journal of Urology, 1994;152(5):1557-1562.

Differential Diagnosis of Scrotal Basal Cell Carcinoma

Scrotal basal cell carcinoma (BCC) is a rare occurrence, and its diagnosis can be challenging due to the scarcity of research on this particular presentation. However, there are several conditions that should be considered in the differential diagnosis of scrotal BCC.

Conditions to Consider:

• Extramammary Paget's disease: This is a rare skin cancer that affects the genital area, including the scrotum. It presents as a red, moist patch or plaque and can be mistaken for scrotal BCC.
• Bowen disease: Also known as squamous cell carcinoma in situ, Bowen disease is a precancerous condition that can progress to invasive cancer if left untreated. It presents as a flat, reddish-brown patch on the skin.
• Squamous cell carcinoma: This is another type of skin cancer that can occur on the scrotum. It typically presents as a firm, red nodule or ulcer.
• Melanoma: Although rare, melanoma can also occur on the scrotum and should be considered in the differential diagnosis.
• Pyoderma gangrenosum: This is a rare skin condition that presents as a painful, ulcerative lesion. It can be mistaken for scrotal BCC due to its similar appearance.

Key Points:

• Scrotal BCC is a rare occurrence and should be considered in the differential diagnosis of any scrotal lesion.
• Extramammary Paget's disease, Bowen disease, squamous cell carcinoma, melanoma, and pyoderma gangrenosum are all conditions that can mimic scrotal BCC.
• A thorough medical history, physical examination, and diagnostic tests (such as biopsy) are essential for accurate diagnosis.

References:

• [8] - Differential diagnosis of basal cell carcinoma of the scrotum includes extramammary Paget's disease and Bowen disease.
• [5] - Differentials for a solitary scrotal skin lesion should include BCC, squamous cell carcinoma, melanoma, extramammary Paget's disease, or pyoderma gangrenosum.
• [6] - The differential diagnosis included BCC, angiokeratoma scroti, and pyogenic granuloma.