P057 Primary squamous cell carcinoma of the scrotum: an analysis of the risk factors, histopathological characteristics and management of 10 patients managed at a specialist centre

• Published in: British journal of dermatology (1951) 2024-06, Vol.191 (Supplement_1), p.i41-i41
• Main Authors: Uppal, Encarl, Pang, Karl, Haider, Aiman, Freeman, Alex, Al Najjar, Hussain, Muneer, Asif, Kravvas, Georgios, Bunker, Christopher
• Format: Article
• Language: English
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1093/bjd/ljae090.084

A recent urological publication from our multidisciplinary team described 10 cases of primary scrotal squamous cell carcinoma (sSCC), but data of potential interest to a dermatological readership were not included. Here we present fresh data concerning risk factors, pathogenesis and histology. Clinical and histopathological features, management and survival outcomes that have been previously published are included for completeness. Data were retrospectively abstracted from patient notes and we gathered collateral history from patients and next of kin. Between 2012 and 2022, 10 cases of primary sSCC were identified and no cases of isolated scrotal Bowen disease (sBD) were identified (i.e. occurring without invasive SCC). The median age at presentation was 65 years (range 29–89; 90% of patients aged > 50 years). Seven of the 10 were ethnically White, 2 of 10 were South Asian and 1 of 10 was African. All 9 evaluable patients had a history of smoking, and 5 of the 9 currently smoked. Three of 8 evaluable patients were deemed to have possible occupational carcinogen exposure (e.g. construction worker, manufacturing industry). One of 8 had definite carcinogen exposure from occupation (nuclear radiation). None of the 9 evaluable patients had iatrogenic risk factor exposure (radiation, ultraviolet B or psoralen plus ultraviolet A, immunosuppression), 1 of 9 had HIV, and 1 of 9 had psoriasis. Two of the 9 reported a positive family history of genital cancer (site not known) and 3 of 9 had a prior extragenital cutaneous malignancy (Kaposi sarcoma, basal cell carcinoma, extragenital SCC). Tumour grades recorded were pT4 (n = 1), pT3 (n = 5), pT2 (n = 1) and pT1 (n = 3). Histological sSCC subtypes identified were condylomatous (2 of 7), not otherwise specified (2 of 7), sarcomatoid (1 of 7), basaloid (1 of 7) and classic (1 of 7). Human papillomavirus (HPV) was initially thought to be positive in 30% of samples; however, further evaluation of histopathological reports revealed that p164ink was positive in three of five (60%) samples tested and HPV is therefore more pathologically significant than initially thought. In four cases the presence or absence of BD was commented on: three (75%) sSCCs were reported arising from background BD. Five of 10 patients (50%) presented with metastatic disease: 2 of 10 had regional lymph node metastases, and 2 of 10 had distant metastases (lungs, liver, bones). All patients were treated surgically (wide local excision with or without