Skin cancer on the scrotum is an uncommon condition originating from the cells of the scrotal skin. This specific type is often treatable, particularly when identified in its early stages. This form of cancer develops on the external skin of the scrotum and is distinct from testicular cancer, which affects the internal testicles. Understanding its appearance, causes, and the medical approach to its management can provide clarity.
Symptoms and Physical Appearance
Potential scrotal skin cancer is identified by observing changes on the skin’s surface. One of the common presentations is a sore or ulcer that persists for several weeks and does not heal. This may be accompanied by itching or bleeding. Another sign is the appearance of a new growth, such as a nodule or plaque, which may be reddish in color and feel firm to the touch.
Changes to existing features on the skin can also indicate a problem. A mole that changes in size, shape, or color warrants attention. Similarly, a rough or scaly patch of skin that might crust over or bleed is a reason for a medical check-up. In some instances, the lesion can look like a wart-like growth. Any new or evolving feature on the scrotal skin should be evaluated by a healthcare professional.
These symptoms often develop slowly, and in the early stages, they may not cause pain or discomfort. The first sign is typically a solitary lesion, often appearing on the anterior, or front-facing, part of the scrotum. Because the symptoms can resemble other, non-cancerous skin conditions, professional medical diagnosis is the only way to confirm or rule out skin cancer. Early detection significantly improves the effectiveness of treatment.
Underlying Causes and Risk Factors
The development of scrotal skin cancer is linked to several factors, with infection from the human papillomavirus (HPV) being a significant contributor in contemporary cases. Certain high-risk strains of HPV are known to cause cancers in the genital region, and studies have found HPV DNA in a notable percentage of scrotal squamous cell carcinomas. This suggests a pathway for cancer development similar to that seen in other genital cancers.
Historically, the first identified occupational cancer was squamous cell carcinoma of the scrotum, known as “chimney sweep’s carcinoma,” due to chronic exposure to soot. This highlights the role of long-term exposure to carcinogens, such as polycyclic aromatic hydrocarbons found in soot, tar, and mineral oils. Though such occupational exposures are now rare, they established that chronic contact with cancer-causing substances can lead to this disease.
Other factors can also increase risk. Chronic inflammation or irritation of the scrotal skin from any source can be a precursor. A compromised immune system, whether from a medical condition or immunosuppressive drugs, can make the body more susceptible. Additionally, a specific type of light therapy called PUVA (psoralen and ultraviolet A), used for conditions like psoriasis, has been associated with a higher risk of developing genital cancers, including on the scrotum.
Types of Scrotal Skin Cancer
Several types of skin cancer can occur on the scrotum, each originating from different cells in the skin. The most prevalent is Squamous Cell Carcinoma (SCC). This type accounts for the majority of scrotal cancer cases and arises from the flat, squamous cells in the outer layer of the skin. SCC on the scrotum can appear as a scaly red patch, an open sore, or a raised growth that may crust or bleed.
A less common type is Basal Cell Carcinoma (BCC). BCC is the most common form of skin cancer overall but is infrequently found on the scrotum because it typically develops on sun-exposed areas. When it does appear on the scrotum, it might look like a pearly or waxy bump, a flat, flesh-colored or brown scar-like lesion, or a bleeding sore that doesn’t heal. Although BCC grows slowly and rarely spreads, on the thin scrotal skin, it may behave more aggressively.
Melanoma is the rarest and most aggressive type of skin cancer that can develop on the scrotum. It originates in the pigment-producing cells called melanocytes. While melanoma accounts for a small fraction of scrotal cancers, it is serious due to its higher likelihood of spreading to other parts of the body. A melanoma lesion may present as a new or changing mole with irregular borders, uneven color, or an increase in size.
The Diagnostic and Treatment Process
Diagnosing scrotal skin cancer begins with a physical examination. During this exam, the healthcare provider will inspect the scrotal skin for any suspicious lesions, noting their size, shape, and texture. If a lesion raises concern, the definitive diagnostic step is a skin biopsy. This procedure involves removing a small sample of the affected tissue, which is then sent to a laboratory for microscopic analysis to confirm the presence and identify the specific type of cancer.
Once a diagnosis of scrotal skin cancer is confirmed, treatment almost always involves surgical removal of the cancerous lesion. The most common procedure is a wide local excision, where the tumor and a surrounding margin of healthy tissue are removed. For certain types of skin cancer or for lesions in cosmetically sensitive areas, a specialized technique called Mohs surgery may be used. In cases where the cancer is more advanced or has spread to the lymph nodes, additional treatments like radiation therapy or chemotherapy may be considered.