A Review of the History, Epidemiology and Treatment of Squamous Cell Carcinoma of the Scrotum

Abstract

Squamous cell carcinoma of the scrotum is a tumor that is of interest for clinical and historical reasons. It was the first cancer linked to occupational exposure when, in 1775, Perivall Pott described it in chimney sweeps in England. Other occupations that had a preponderance of the disease included people who worked with the distillates of coal and men exposed to mineral oil. Currently, the disease is very rare and most cases are thought to result from poor hygiene and chronic irritation. Surgery with a negative resection margin offers the best hope of cure as adjunctive therapy has not proved useful. Prognosis correlates with the extent of nodal involvement.

Scrotal Abscess as Initial Presentation of Squamous Cell Carcinoma

“…It has subsequently been associated with exposure to tar, arsenic, paraffin, shale oil, petroleum wax, sun exposure, and human papillomavirus [2]. Currently, most cases are thought to result from poor hygiene and chronic inflammation [3]. SCC of the scrotum is most frequently diagnosed in the sixth and seventh decades.…”

“…It typically presents as a solitary, painless, and slow-growing nodule. Ulceration may follow with an increase in lesion size, and the area can become infected [3]. …”

Proliferating Trichilemmal Tumor Presenting as a Scrotal Mass in a Middle-Aged Male: An Uncommon Location

“…PTT typically presents as a solitary, painless nodule, ranging in size from 1 to 10 cm. Although the majority (90%) present on the scalp, other hair-bearing anatomic sites, including the trunk, and rarely the extremities, nose, eyelid and vulva, can also be involved [9]. There is a marked female predominance.…”

“…Keratin pearls can be present throughout the tumor depending on its level of differentiation. Although surgical excision is also the primary treatment for SCC, current guidelines require a wider margin (range 4 mm -3 cm) than PTT [9,15]. Additionally, due to the fact that the raphe of the scrotum does not provide a physical barrier to scrotal lymphatic drainage and that the scrotum has bilateral inguinal drainage, secondary treatments such as (1) inguinal sentinel lymph node dissection (ILND) / subsequent complete ILND in cases with clinical or histologic evidence for regional spread of disease and (2) palliative chemotherapy for locally advanced and metastatic disease are advocated for SCC [15,2,16].…”

“…Although occupational SCC is likely due to exposure to carcinogenic polycyclic aromatic hydrocarbons, its incidence overall remains high as new risk factors, such as phototherapy for cutaneous conditions and human papilloma virus (HPV) have emerged [5]. The most common clinical and histologic differential diagnoses for SCC of the scrotum include epidermal inclusion cyst, extramammary Paget's disease, basal cell carcinoma, melanoma, and adnexal skin tumors [9]. This paper aims to add one more entity to this differential: proliferating trichilemmal tumor (PTT), as it can be clinically and histologically confused with the more common SCC of the scrotum, and has significantly different prognostic and treatment ramifications.…”