New insights into the aetiology of scrotal cancer, a nationwide case-control study in the Netherlands

Primary squamous cell carcinoma of the scrotum: Outcomes from a specialist center

BACKGROUND

Squamous cell carcinoma (SCC) of the scrotum is a rare and aggressive cancer. There are no established guidelines on the management of scrotal SCC.

OBJECTIVE

To analyze the clinical management and outcomes of scrotal SCC.

PATIENTS AND METHODS

A retrospective analysis of patients diagnosed with primary scrotal SCC over a 10-year period was performed. The type of surgery, tumor stage and histological subtypes, recurrence rate and metastases, cancer-specific mortality (CSM), and other-cause mortality (OCM) were analyzed.

RESULTS

Between 2012 and 2022, a total of 10 men were identified with primary scrotal SCC. The median (interquartile, IQR) age was 65.5 (55-77) years. Wide local excision was performed in 9 patients and 1 patient underwent a total scrotectomy. The pathological T-stage was: pT1, n = 3; pT2, n = 1; pT3, n = 5 (50%); pT4, n = 1. Four patients had pathologically positive inguinal lymph nodes and 2 had distant metastatic disease at presentation. At a median (IQR) follow-up of 10.5 (4-31) months 5 patients died, of which 3 died from scrotal SCC.

CONCLUSION

Scrotal SCC is extremely rare in the UK with only 10 primary cases identified in our center over the past 10 years. Surgical resection of the tumor and appropriate inguinal node staging are required due to a high proportion of cases which metastasize to the inguinal lymph nodes.

PATIENT SUMMARY

Scrotal cancer is rare. 10 cases were diagnosed over 10 years at a single center. Around half had disease spread to the groin nodes or distant organs at presentation. Surgical resection was required in all patients. At the time of analysis, half of the patients are alive. Due to the rarity and aggressiveness of the cancer, management should be carried out within a specialist center.

Recurrence or de novo? Intradermal Basal Cell Carcinoma of the Scrotum: A Report of Two Cases

Basal cell carcinoma (BCC) is the most common cutaneous malignancy, usually occurring in sun-exposed areas. Although BCC in the scrotal region is uncommon, it carries a higher risk of metastasis than BCC at other sites. Here, we report two cases of BCC that developed in the scrotal region: Case 1 presented as a superficial nodule and Case 2 as a subcutaneous nodule. Histopathologically, both tumors lacked continuity with the surface epidermis and formed an intradermal nodule. In Case 1, BCC occurred for the first time and presumably developed de novo. Case 2 underwent excision of a scrotal BCC 5 years previously, and the histopathological diagnosis at that time was nodular BCC. However, when the original specimen was re-examined, it was determined that, although the tumor had been completely resected, part of the lesion had moved away from the nodular area to represent a micronodular phenotype, an aggressive BCC subtype. We hypothesized that partial evolution from a nodular to a micronodular phenotype may have contributed to the recurrence of BCC in Case 2.

Evaluating the Public's Interest in Testicle Tanning: Observational Study

BACKGROUND

A new and potentially dangerous health trend, testicle tanning, received extensive media attention following a popular television program where a health and fitness influencer touted that testicular tanning increases testosterone levels. It has been shown that the public has a particular interest in tanning wellness trends; thus, given the vague nomenclature of the practice, the abundance of misleading information and support for using UV light by other health influencers may lead to an increase in men exposing themselves to UV radiation and developing associated complications.

OBJECTIVE

The aim of this paper is to evaluate the public's interest in testicle tanning.

METHODS

Relative search interest was collected from Google Trends, and daily tweet volume was collected using Twitter via Sprout Social. The search was filtered to observe internet activity between February 1, 2022, and August 18, 2022. Autoregressive integrated moving average models were applied to forecast the predicted values through April 30 to compare to the actual observed values immediately following the airing of the show.

RESULTS

We found that the relative search interest for testicle tanning peaked (100) on April 19, 2022, following a discussion of the topic on a television program. Compared to the forecasted relative search interest of 1.36 (95% CI -3.29 to 6.01), had the topic not been discussed, it showed a 7252% increase in relative search interest. A similar spike was observed in the volume of tweets peaking on April 18 with 42,736. The expected number of tweets from the autoregressive integrated moving average model was 122 (95% CI -154 to 397), representing a 35,053% increase.

CONCLUSIONS

Our results show that the promotion of testicle tanning generated significant public interest in an evidence-lacking and potentially dangerous health trend. Dermatologists and other health care professionals should be aware of these new viral health trends to best counsel patients and combat health misinformation.

Basal Cell Carcinoma of the External Genitalia: A Population-Based Analysis

Introduction

Basal cell carcinoma (BCC) located on the genitalia is rare; data on the clinicopathologic features and survival outcomes are only available through case reports and small case series studies.

Purpose

This study aimed to explore the epidemiology and identify the prognostic factors of genital BCCs.

Methods

We queried the 18 registries of the Surveillance, Epidemiology, and End Results database for patients with primary BCCs of the genital skin from 2000 through 2017. The primary endpoint was overall survival (OS) and disease specific survival (DSS). Kaplan-Meier survival analysis was conducted to assess the impact of clinicopathological variables on OS and DSS. Multivariate Cox proportional hazards model was performed to evaluate risk factors for OS.

Results

A total of 1,607 cases of genital BCCs were identified. The cohort was composed of 1,352 women (84.1%) and 255 men (15.9%). The median (P25, P75) age of the entire cohort was 73(63–82)years. White patients accounted for 87.2% of the cases. For women and men, the most common site of involvement was the labia majora (89.6%) and scrotum (74.5%), respectively. The majority of patients with genital BCC had localized disease (75.5%). Kaplan-Meier survival analysis showed that female genital BCCs experienced better DSS than men (209.1 months vs 194.8 months); for men, BCCs located on the scrotum had better DSS and OS than those on the penis (P < 0.05 for both endpoints). All patients with distant disease died of disease-specific death, and the average survival time was 8.2 months. Multivariate analysis revealed that age, primary site, and stage were independent determinants of OS for men, while tumor size, histologic subtype, and race were not. For women, factors associated with worse OS included increasing age, tumor size more than 2 cm, and distant disease; factors associated with a decreased risk included “other” and “unknown” races.

Conclusion

The prognosis of genital BCCs is excellent, while the survival of distant disease is very poor. Despite similar clinicopathologic features and overall survival outcomes, men and women should be treated as two different entities when making survival predictions.