Introduction: Idiopathic scrotal calcinosis (ISC) is a rare, benign condition characterized by painless, calcified nodules within the scrotal dermis. Although typically asymptomatic, progressive growth and cosmetic concerns often lead patients to seek surgical intervention. Case Presentation: We report a 35-year-old male with multiple asymptomatic scrotal nodules progressively enlarging over 3 years. Physical examination revealed firm, subcutaneous nodules ranging from 2 to 20 mm. Laboratory investigations, including serum calcium, phosphate, and parathyroid hormone, were unremarkable. Histopathological examination confirmed the diagnosis of ISC, revealing basophilic calcified deposits within a fibrous stroma without cystic epithelial lining, consistent with dystrophic calcification. Intervention: A "pinch-and-punch" excision technique was performed under regional anesthesia supplemented by tumescent local infiltration. Individual nodules were elevated by pinching the overlying scrotal skin, followed by targeted removal using 2-4 mm disposable biopsy punches. No sutures were required. Outcome: The procedure was completed with minimal bleeding and no intraoperative or postoperative complications. Complete epithelialization occurred within 1 week via secondary intention. At 3-month follow-up, no recurrence was observed and the patient reported high satisfaction with the aesthetic outcome. Conclusion: The pinch-and-punch excision technique-distinguished by its combination of the tissue-elevation pinching maneuver, tumescent infiltration for hydrodissection, and sutureless wound management-is a safe and cosmetically favorable approach to ISC, particularly for patients with multiple nodules. Histopathological confirmation remains essential. Further prospective studies with longer follow-up are warranted.
Krittin Naravejsakul (Thu,) studied this question.