Abstract Introduction Basal cell carcinoma (BCC) is the most prevalent non-melanoma skin cancer, accounting for nearly 80% of all cases, and it most commonly occurs in sun- exposed areas such as the head and neck. Genital involvement is exceedingly rare, representing less than 1% of all BCCs, and is often diagnosed at a more advanced stage due to patient delay, misdiagnosis, or lack of symptoms. When arising in high-risk sites such as the penis or scrotum, BCC may display more aggressive histologic features and an increased potential for local invasion or metastasis. Objective To describe the diagnostic approach, surgical management, and reconstructive strategy in a rare case of penoscrotal BCC, emphasizing the importance of a multidisciplinary perspective to achieve optimal oncologic and functional outcomes. Methods A 66-year-old male with a prior history of nasal BCC presented with multiple ulcerated and recurrent genital skin lesions. Clinical evaluation, magnetic resonance imaging, and flexible cystoscopy ruled out invasion of the corpora cavernosa, urethra, and testicles. The case was reviewed by a multidisciplinary team including urologists, plastic surgeons, oncologists, dermatologists, radiologists, and psychologists. Surgical treatment consisted of a wide local excision of all affected penile and scrotal skin with glansectomy, followed by complex reconstruction using bilateral Singapore flaps for the scrotum, a Keystone flap for the penile base, and a split-thickness skin graft from the anterior thigh. All resected specimens underwent detailed histopathologic assessment. Results Histologic examination confirmed infiltrative, multicentric BCC with vascular and perineural invasion, extending into the corpus spongiosum of the glans. The postoperative course was uneventful, except for minor distal flap necrosis managed conservatively. Complete wound healing was achieved within six weeks, with satisfactory cosmetic and functional results. The patient preserved spontaneous erectile function of the penile stump, though with mild deformity and reduced sensitivity. Given the tumor’s aggressive histologic features, close clinical and radiologic follow-up every three months was recommended. To date, no evidence of recurrence or metastasis has been observed. Conclusions Penoscrotal BCC represents a rare but clinically relevant entity posing diagnostic and therapeutic challenges. Persistent or atypical genital lesions should prompt early biopsy to exclude malignancy. Timely diagnosis allows for curative, organ-sparing surgery and reduces physical and psychological morbidity. This case illustrates that extensive yet function-preserving excision combined with tailored reconstructive techniques can ensure satisfactory oncologic and functional results. Due to the potential aggressiveness and recurrence risk of penoscrotal BCC, vigilant long-term follow-up is essential to maintain disease control and quality of life. Disclosure No
Rosa et al. (Mon,) studied this question.