Rare occurrence of penoscrotal basal cell carcinoma: Clinicopathologic findings from a single institution cohort and comprehensive literature review.

Abstract

Basal cell carcinoma (BCC) is a frequently diagnosed cancer often associated with increased cumulative sun exposure. BCCs rarely occur on sun-protected areas, such as the external genitalia. Herein, we present the largest single-institution case series and comprehensive literature review of penoscrotal BCC. We performed a retrospective analysis of penoscrotal BCC cases diagnosed between 2000 and 2023 and collected information regarding demographics, risk factors, clinicopathologic features, treatment, and outcome. Available slides were reviewed by an experienced dermatopathologist and a genitourinary pathologist, and risk categories were assigned based on histologic subtype in accordance with the current World Health Organization (WHO) classification guidelines. Twenty cases of scrotal BCC and two cases of penile BCC were diagnosed during the study period. Reported risk factors included other non-melanoma skin cancer involving sun-exposed areas (42.9%) and sun-protected areas (9.5%), tobacco use (42.9%), chronic kidney disease (19%), moderate to severe sun exposure (14%), immunosuppressive/modulatory medication (9.5%), external beam radiation, and psoriasis. The median age at time of diagnosis, time to presentation, and lesion size were 69 years, 0.5 years, and 1.5 cm, respectively. Among the recognized subtypes, nodular BCC occurred most frequently (68.4%) and overall most cases (63%) were categorized as low risk. All nineteen cases with available treatment information had been treated with either Mohs (21%), excision (74%), or both (5%). No metastases were reported, and 75% of patients were alive without recurrence at follow-up. Our case series highlights important insights regarding penoscrotal BCC and increases knowledge and awareness of an unusual presentation of a common entity.