Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA.
Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA.
Urol Oncol. 2021 Aug;39(8):501.e11-501.e16. doi: 10.1016/j.urolonc.2021.05.019. Epub 2021 Jun 27.
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.
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.
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.
阴囊的鳞状细胞癌（SCC）和外分泌性 Pagets 病（EMPD）极为罕见。由于它们具有局部侵袭性，需要广泛的局部切除，因此可能是高度病态的疾病。Mohs 显微外科手术（MMS）治疗阴囊皮肤恶性肿瘤的结果在当前文献中描述得并不充分。我们假设 MMS 治疗阴囊皮肤恶性肿瘤可以提供同等或更好的肿瘤学结果，同时限制广泛切除相关的发病率。
材料/方法： 这是一项回顾性研究，分析了 2005 年至 2019 年期间前瞻性维护的数据库中的病例。收集的数据包括一般患者特征和每例病变的手术特征。MMS 由我们机构的皮肤科使用他们的标准技术进行。
总体而言，共有 26 例连续患者，28 处病变（SCC 或 EMPD）接受了分析。在我们的 15 例 16 处阴囊 SCC 病变患者中，有 10 例（66%）为现吸烟或曾吸烟患者，4 例（26%）为免疫抑制患者，2 例（13%）有 HPV 感染。SCC 病变的术前和术后大小中位数分别为 5.7cm[2]和 20.2cm[2]。有 1 例（6%）阴囊 SCC 复发，1 例（6%）出现局部伤口并发症。我们的队列还包括 11 例 12 例阴囊 EMPD 病变患者。1 例（9%）患者有潜在的相关恶性肿瘤（前列腺癌）。病变的术前和术后面积分别为 50.6cm[2]和 96.4cm[2]。1 例（9%）EMPD 病变在切除时切缘阳性，需要再次手术。在获得阴性手术切缘后，该队列中无患者出现肿瘤复发。3（26%）阴囊 EMPD 病例术后局部伤口并发症，仅 1 例需要再次手术。
据我们所知，这是首个专注于 MMS 治疗阴囊 SCC 和 EMPD 合并受累的病例系列。我们的数据表明，与广泛局部切除治疗的报告结果相比，MMS 治疗阴囊皮肤恶性肿瘤可能改善肿瘤学结果，并可能减少术后局部重建问题。当能够做到时，阴囊皮肤恶性肿瘤患者应被转介至具有 MMS 能力的泌尿科医生处，因为这可能会改善他们的结果。泌尿科医生应保持对这些患者的积极参与，以协调这种复杂和先进的护理模式。
