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Abstract A recent urological publication from our multidisciplinary team described 10 cases of primary scrotal squamous cell carcinoma (sSCC), but data of potential interest to a dermatological readership were not included. Here we present fresh data concerning risk factors, pathogenesis and histology. Clinical and histopathological features, management and survival outcomes that have been previously published are included for completeness. Data were retrospectively abstracted from patient notes and we gathered collateral history from patients and next of kin. Between 2012 and 2022, 10 cases of primary sSCC were identified and no cases of isolated scrotal Bowen disease (sBD) were identified (i.e. occurring without invasive SCC). The median age at presentation was 65 years (range 29–89; 90% of patients aged 50 years). Seven of the 10 were ethnically White, 2 of 10 were South Asian and 1 of 10 was African. All 9 evaluable patients had a history of smoking, and 5 of the 9 currently smoked. Three of 8 evaluable patients were deemed to have possible occupational carcinogen exposure (e.g. construction worker, manufacturing industry). One of 8 had definite carcinogen exposure from occupation (nuclear radiation). None of the 9 evaluable patients had iatrogenic risk factor exposure (radiation, ultraviolet B or psoralen plus ultraviolet A, immunosuppression), 1 of 9 had HIV, and 1 of 9 had psoriasis. Two of the 9 reported a positive family history of genital cancer (site not known) and 3 of 9 had a prior extragenital cutaneous malignancy (Kaposi sarcoma, basal cell carcinoma, extragenital SCC). Tumour grades recorded were pT4 (n = 1), pT3 (n = 5), pT2 (n = 1) and pT1 (n = 3). Histological sSCC subtypes identified were condylomatous (2 of 7), not otherwise specified (2 of 7), sarcomatoid (1 of 7), basaloid (1 of 7) and classic (1 of 7). Human papillomavirus (HPV) was initially thought to be positive in 30% of samples; however, further evaluation of histopathological reports revealed that p164ink was positive in three of five (60%) samples tested and HPV is therefore more pathologically significant than initially thought. In four cases the presence or absence of BD was commented on: three (75%) sSCCs were reported arising from background BD. Five of 10 patients (50%) presented with metastatic disease: 2 of 10 had regional lymph node metastases, and 2 of 10 had distant metastases (lungs, liver, bones). All patients were treated surgically (wide local excision with or without inguinal lymph node dissection). Distant metastases were treated with radiotherapy with or without systemic anticancer therapy. Five of 10 (50%) patients were recorded deceased during a median follow-up 10.5 of months (range 4–31). Three of 5 deaths were attributable to sSCC, with an average time from diagnosis to death of 117 days (range 49–158). Primary sSCC presents with advanced disease and has a high mortality rate. HPV and smoking seem to be key aetiological factors in the development of sSCC. No cases of isolated sBD were identified, yet sSCC was found to have arisen from BD in 75% of cases (3 of 4). This may be explained by delayed presentation of sBD or a greater risk of transformation to invasive disease compared with extragenital BD.
Uppal et al. (Fri,) studied this question.