Most bumps on the scrotum are harmless. The scrotal skin is packed with hair follicles, sweat glands, and oil glands, which makes it one of the body’s most bump-prone surfaces. Epidermoid cysts, tiny vascular spots called angiokeratomas, and even calcium deposits all show up here with surprising regularity. That said, the range of possibilities is wide enough that knowing what different bumps look and feel like can save you both needless worry and an avoidable delay in getting something checked.
Epidermoid Cysts
If you have one or more firm, round, whitish or yellowish bumps embedded in the scrotal skin, there’s a good chance you’re looking at epidermoid cysts. These are the most common type of benign scrotal lump. They form when skin cells get trapped beneath the surface and produce keratin, a protein that gradually fills the cyst into a pea-sized (or occasionally larger) nodule. They’re painless unless they become inflamed or infected.
How exactly epidermoid cysts form on the scrotum is still debated. Theories include trapped skin tissue from early embryonic development, displacement of surface cells into deeper layers after minor trauma, and abnormal closure along the midline seam (the raphe) that runs down the center of the scrotum.1PubMed Central. Multiple scrotal and testicular epidermoid cysts: A rare case report Whatever the trigger, the end result is the same: a slow-growing, enclosed pocket of dead skin cells.
Epidermoid cysts generally do not need treatment. Many people live with them for years without any problems. A doctor might recommend removal if a cyst grows large enough to be uncomfortable or cosmetically bothersome, or if it ruptures and becomes infected. In one reported case, a ruptured scrotal epidermoid cyst led to a painful abscess containing bacteria, requiring drainage and antibiotics.2PubMed. Rupture of intrascrotal epidermoid cyst complicated by bacterial infection: a case report That outcome is unusual but worth knowing about: if a previously painless bump suddenly becomes red, swollen, and tender, have it looked at promptly.
Angiokeratomas of Fordyce
Dark red, purple, or near-black spots on the scrotum that look a bit like tiny blood blisters are usually angiokeratomas. Specifically, the type found on the scrotum is called angiokeratoma of Fordyce. These are clusters of dilated blood vessels sitting just under the skin surface, covered by a slightly thickened layer of skin. They’re typically 1 to 2 millimeters across and can number from a handful to more than 50.3PubMed Central. Angiokeratoma of the scrotum: a case of scrotal bleeding
Angiokeratomas are benign and generally painless. They become more common with age, especially after 40. The main annoyance is cosmetic, though they can occasionally bleed if scratched or caught on clothing. That bleeding can be alarming because genital skin is highly vascular, but it stops with gentle pressure and is not dangerous.
The reason angiokeratomas matter beyond cosmetics is that they can be mistaken for something more serious. Their dark coloring sometimes triggers concern about melanoma, and their bumpy texture can look like genital warts. A dermatologist can usually tell the difference on sight, but when there’s doubt, a small biopsy settles the question. Doctors also check that scrotal angiokeratomas are not part of a rare systemic condition called Fabry disease, which causes similar-looking spots all over the body along with organ damage.4PubMed Central. Unusual Genital Wart Lesions: A Case Series on Angiokeratoma of Fordyce When the spots are limited to the scrotum, Fabry disease is almost certainly not the cause.
Scrotal Calcinosis
Some men develop hard, stone-like nodules in the scrotal skin that feel gritty or chalky when pressed. This is scrotal calcinosis, a condition in which calcium deposits accumulate within the skin of the scrotum. The nodules range from a few millimeters to over a centimeter, and there can be anywhere from a handful to dozens scattered across the scrotal surface.5PubMed Central. Idiopathic scrotal calcinosis: a non-elucidated pathogenesis and its surgical treatment
Scrotal calcinosis is painless and benign. It tends to show up in younger men, often during their twenties or thirties, and progresses slowly. The condition has been labeled “idiopathic” for decades, meaning doctors couldn’t find a clear cause. But research has challenged that label. One study examining tissue from patients with scrotal calcinosis found epidermoid cysts in various stages of breakdown sitting right alongside the calcium nodules, with keratin and calcium granules spilling into surrounding tissue where cyst walls had ruptured.6PubMed. Scrotal calcinosis: is it idiopathic? The implication is that at least some cases of scrotal calcinosis start as epidermoid cysts that slowly calcify over time.
Treatment is optional and purely cosmetic. Surgical excision of the affected scrotal skin works well and recurrence is uncommon. Many men choose to leave the nodules alone once they know the lumps are not harmful.
Steatocystoma Multiplex
A less common but still benign condition, steatocystoma multiplex produces multiple smooth, yellowish or skin-colored cystic bumps. Unlike epidermoid cysts, these form from the oil glands (sebaceous glands) and contain an oily, sometimes semi-solid material rather than keratin. They tend to appear in clusters and grow slowly over months to years. In one documented case, a 22-year-old man presented with numerous smooth cystic nodules covering the entire scrotum, with biopsy confirming cyst walls lined with flattened sebaceous gland cells.7PubMed Central. Steatocystoma Multiplex of Scrotum
Steatocystoma multiplex is usually painless, but the cysts can become inflamed and tender if bacteria get in. One case report described a 64-year-old man whose scrotal steatocystomas developed active inflammation with pain, swelling, and redness.8Andrology and Genital Surgery. Steatocystoma multiplex of the scrotum. Clinical case In most people, though, the bumps sit quietly and the main concern is appearance. Surgical excision or drainage is an option for those who want them removed.
Lumps Below the Skin Surface
Not every lump you feel in the scrotum comes from the skin itself. The scrotum houses the testicles, the epididymis (the coiled tube that stores sperm behind each testicle), and the spermatic cord. Bumps arising from these structures feel different from skin bumps: they’re deeper, and they move with the testicle when you shift it around.
Epididymal cysts and spermatoceles are among the most common deeper lumps. Both are fluid-filled, both are benign, and both sit near the top or behind the testicle. The terms are sometimes used interchangeably, though they’re slightly different: an epididymal cyst contains clear fluid, while a spermatocele contains fluid with sperm cells.9PubMed. Epididymal cyst in children An ultrasound can easily distinguish the two, though the distinction rarely changes management. Most are found incidentally during a physical exam or imaging done for another reason, and most need no treatment at all. Surgery is reserved for cysts that become large enough to cause discomfort or a dragging sensation.10PubMed. Pro-inflammatory cytokine response of the fluid contents of spermatoceles and epididymal cysts
A varicocele, which is a collection of dilated veins in the spermatic cord, can also feel like a soft lump or a “bag of worms” above the testicle. Varicoceles are very common, especially on the left side, and are another benign finding that usually requires no treatment unless fertility is a concern.
Itchy, Inflamed, or Recurring Bumps
If your scrotal bumps itch, ooze, or keep coming back, the explanation is more likely a skin condition or infection than a simple cyst.
Scrotal dermatitis is a broad term for eczema-like inflammation of the scrotal skin. It causes redness, scaling, intense itching, and sometimes small raised patches that could be mistaken for discrete bumps. It’s frequently confused with a fungal infection (jock itch), but standard antifungal creams often don’t help because the underlying problem is irritant or allergic contact dermatitis, not a fungus.11PubMed Central. Scrotal Dermatitis – Can we Consider it as a Separate Entity? Common triggers include synthetic underwear, laundry detergent residue, body washes, and prolonged moisture. Treatment usually involves identifying and removing the irritant, keeping the area dry, and using a mild topical steroid.
Scabies is a parasitic infection caused by tiny mites that burrow into the skin. The genital area is one of their preferred sites. Scabies typically produces small, intensely itchy papules a few millimeters across. In rare cases, these develop into larger nodular lesions on the scrotum that can persist for weeks even after the mites are killed, because the immune system keeps reacting to residual mite proteins in the skin.12PubMed Central. Scrotal nodular scabies Nodular scabies is sometimes misdiagnosed as cysts or even tumors, so it’s worth mentioning to your doctor if the bumps appeared alongside whole-body itching that’s worse at night.
Genital warts caused by human papillomavirus (HPV) are another possibility. They appear as soft, flesh-colored or slightly darker growths with an irregular, cauliflower-like surface. They can show up on the scrotal skin, the shaft of the penis, or the perianal area. Warts are usually painless and diagnosed on appearance alone, though a biopsy can confirm ambiguous cases. Various topical treatments and in-office procedures can remove them, but recurrence is common because the virus can persist in surrounding skin.
Hidradenitis Suppurativa
Hidradenitis suppurativa (HS) is a chronic inflammatory condition of the hair follicles that produces painful nodules, abscesses, and tunneling sinus tracts under the skin.13JAMA Surgery. Multidisciplinary Update on Genital Hidradenitis Suppurativa: A Review It’s most commonly associated with the armpits and groin folds, but scrotal involvement occurs in roughly 6% of men with HS.14International Journal of Impotence Research. Management of penoscrotal hidradenitis: a narrative review
The bumps of HS look and feel different from cysts. They tend to be deeper, more painful, and they recur in the same areas. Over time, flares can leave behind thickened scar tissue and draining tunnels under the skin. The condition is frustrating to treat: medical therapy for extensive penoscrotal HS often has poor results, and diagnosis is frequently delayed by a decade or more because patients feel too embarrassed to seek help.14International Journal of Impotence Research. Management of penoscrotal hidradenitis: a narrative review That delay matters. Untreated HS in the scrotal and perineal region can lead to severe complications including lymphedema, and in rare cases, even squamous cell carcinoma arising within chronically inflamed tissue.15PubMed Central. Scroto-perineal hidradenitis suppurativa complicated by giant scrotal elephantiasis
If you’re dealing with recurring painful lumps that drain pus and always seem to come back in the same spots, bring it up with a dermatologist or surgeon sooner rather than later. Earlier intervention tends to preserve more tissue and prevent the scarring cycle that makes advanced HS so difficult to manage.
When a Bump Could Be Something Serious
The overwhelming majority of scrotal bumps are benign. But a small number of serious conditions can start as unremarkable-looking lumps, and knowing the warning signs is worthwhile.
Scrotal squamous cell carcinoma (SCC) is rare but does occur. It typically shows up in men in their 50s or 60s as a single painless nodule that gradually enlarges, eventually ulcerating and becoming infected.16Journal of Surgical Case Reports. Scrotal squamous cell carcinoma: a case report The same embarrassment factor that delays HS diagnosis plagues scrotal SCC as well; men put off getting checked because the location feels awkward to discuss. A bump that won’t heal, keeps growing, or develops an open sore that doesn’t close warrants a visit.
Scrotal melanoma is even rarer but more dangerous. It tends to present at a much more advanced stage than melanoma found on other parts of the body. While typical skin melanoma is caught at Stage I or II about 84% of the time, scrotal melanoma presents that early in fewer than one in five cases. More than half of patients already have regional spread (Stage III) at diagnosis, and a quarter have distant metastases.17Dermatologic Surgery. Scrotal Melanoma: A Systematic Review of Presentation, Treatment, and Outcomes The reason for this disparity is straightforward: people rarely look at their scrotum the way they check a mole on their arm, and the dark, uneven pigmentation of normal scrotal skin makes new spots harder to notice. Any new pigmented lesion that is growing, changing color, or bleeding deserves prompt evaluation.
For deeper lumps, the concern shifts to the testicle itself. A hard, painless lump attached to the testicle (as opposed to sitting in the skin above it) should always be evaluated by a doctor. In a clinic that offered same-day scrotal ultrasound to men presenting with testicular concerns, about 4% turned out to have testicular cancer, while the vast majority had normal findings or minor abnormalities and could be reassured.18Annals of the Royal College of Surgeons of England. A one-stop clinic for men with testicular anxiety Those numbers tell the story well: serious disease is uncommon, but it isn’t nonexistent, and finding it early makes a large difference in outcomes.
Scrotal Self-Checks and the Anxiety Factor
The scrotum is a body part many people never inspect closely, so discovering bumps that have probably been there for years can set off a spiral of worry. That worry is understandable. The same testicular anxiety clinic referenced above found that the large majority of men who came in concerned about a lump left with nothing more than reassurance.18Annals of the Royal College of Surgeons of England. A one-stop clinic for men with testicular anxiety Many of the “lumps” patients were worried about turned out to be normal anatomy: the epididymis, the appendix testis (a tiny embryonic remnant), or benign cysts they’d simply never noticed before.
Getting familiar with what your scrotum normally looks and feels like makes it much easier to notice genuine changes. A monthly self-check after a warm shower, when the scrotal skin is relaxed, takes less than a minute. You’re feeling for anything new, anything hard and fixed to the testicle, or anything that’s changed since last time. Skin bumps that are symmetric, multiple, and have been stable for months or years are almost always benign. A single new lump that feels different from its surroundings, especially if it’s growing, is the kind of finding worth calling a doctor about.
If you’re unsure what you’re feeling, a scrotal ultrasound is a quick, painless, widely available test that resolves most ambiguity. There’s no downside to getting one when you’re genuinely concerned. The discomfort of an awkward appointment lasts a few minutes; the peace of mind, or the early diagnosis if something does need attention, lasts much longer.