Introduction

Squamous cell carcinoma (SCC) and extramammary Paget's Disease (EMPD) of the scrotum are exceedingly rare. Given their propensity for local invasion and treatment with wide local excision, they can be highly morbid conditions. Outcomes of Mohs Micrographic Surgery (MMS) for scrotal cutaneous malignancy is not well described in current literature. We hypothesized that MMS for scrotal cutaneous malignancy would provide equivalent or improved oncologic outcomes while limiting the morbidity associated with wide excision.

Materials/Methods

This is a retrospective review and analysis of a prospectively maintained database spanning entries from 2005 to 2019. Collected data included general patient characteristics and surgical characteristics reported on a per lesion basis. MMS was performed by our institution's department of dermatology using their standard technique.

Results

Overall, a total of 26 consecutive patients with 28 lesions (SCC or EMPD) were analyzed. Out of our cohort of 15 patients with 16 scrotal SCC lesions, 10 (66%) patients were current or former smokers, 4 (26%) were immunosuppressed, and 2 (13%) had HPV infections. The median preoperative and postoperative size of SCC lesions were 5.7cm [2] and 20.2cm [2] respectively. There was one (6%) oncologic recurrence of SCC of the scrotum and one (6%) local wound complication. Our cohort also included 11 patients with 12 scrotal EMPD lesions. One patient (9%) had an underlying associated malignancy (prostate cancer). The preoperative and postoperative area of lesions were 50.6cm [2] and 96.4cm [2] respectively. One (9%) EMPD lesion had a positive final margin at resection requiring reoperation. After achieving negative surgical margins, no patients in this cohort had an oncologic recurrence. 3 (26%) scrotal EMPD cases had local wound postoperative complications, only one required reoperation.

Conclusion

To our knowledge, this is the first case series focused on MMS for both SCC and EMPD with scrotal involvement. Our data suggests that MMS for scrotal cutaneous malignancy may improve oncologic outcomes and may decreases local post-operative reconstructive issues when compared to reported outcomes of treatment with wide local excision. When able, scrotal cutaneous malignancy patients should be referred to urologists at centers with MMS capabilities as it likely will improve their outcomes. The urologist should maintain active involvement with these patients to coordinate this complex and advanced pattern of care.

中文翻译：

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mohs显微切除术治疗累及阴囊的皮肤恶性肿瘤的结果

介绍

阴囊的鳞状细胞癌 (SCC) 和乳房外佩吉特病 (EMPD) 极为罕见。鉴于它们具有局部侵袭和广泛局部切除治疗的倾向，它们可能是高度病态的疾病。莫氏显微手术 (MMS) 治疗阴囊皮肤恶性肿瘤的结果在当前文献中没有得到很好的描述。我们假设用于阴囊皮肤恶性肿瘤的 MMS 将提供等效或改善的肿瘤学结果，同时限制与广泛切除相关的发病率。

材料/方法

这是对涵盖 2005 年至 2019 年条目的前瞻性维护数据库的回顾性审查和分析。收集的数据包括按病灶报告的一般患者特征和手术特征。MMS 由我们机构的皮肤科使用他们的标准技术进行。

结果

总体而言，共分析了 26 名具有 28 个病变（SCC 或 EMPD）的连续患者。在我们的 15 名有 16 个阴囊 SCC 病变的患者队列中，10 名 (66%) 患者目前或以前吸烟，4 名 (26%) 免疫抑制，2 名 (13%) 有 HPV 感染。SCC 病灶术前和术后中位大小分别为 5.7cm [2] 和 20.2cm [2]。有 1 例 (6%) 阴囊 SCC 肿瘤复发和 1 例 (6%) 局部伤口并发症。我们的队列还包括 11 名有 12 处阴囊 EMPD 病变的患者。一名患者 (9%) 患有潜在的相关恶性肿瘤（前列腺癌）。术前、术后病灶面积分别为50.6cm[2]和96.4cm[2]。一个 (9%) EMPD 病灶在切除时具有阳性的最终切缘，需要再次手术。在达到阴性手术切缘后，该队列中没有患者出现肿瘤复发。3 例（26%）阴囊 EMPD 病例有局部伤口术后并发症，仅 1 例需要再次手术。

结论

据我们所知，这是第一个针对 SCC 和 EMPD 的 MMS 涉及阴囊的病例系列。我们的数据表明，与报道的广泛局部切除治疗的结果相比，用于阴囊皮肤恶性肿瘤的 MMS 可能会改善肿瘤学结果，并可能减少局部术后重建问题。如果可能，应将阴囊皮肤恶性肿瘤患者转诊给具有 MMS 能力的中心的泌尿科医生，因为这可能会改善他们的预后。泌尿科医生应保持积极参与这些患者的工作，以协调这种复杂而先进的护理模式。