A Systematic Review of Scrotal Squamous Cell Carcinoma

Abstract

The epidemiology of scrotal cancer has changed over time away from occupational exposure to soot. The current incidence of scrotal malignancy is approximately 1 per 1 million males per year. This review summarises the current literature on the management of scrotal squamous cell carcinoma (SCC), including pathogenesis, available diagnostic tools, current treatment, and overall management strategies. The rarity of SSC cases makes it difficult to recruit patients for studies of this disease. To date, very few studies have been performed, and those that have been completed were limited by a small sample size. This review analyses all available evidence, which varies from retrospective case series to prospective multicentre trials. Psoralen ultraviolet light A treatment and human papillomavirus infection are significant risk factors for this cancer. Scrotal SCC had lower survival rates compared with other histological subtypes and the 5-year relative survival rate was 77%. Many studies also showed a positive margin, even after wide excision of the lesion. Excision of the primary lesion and a risk-stratified approach for staging and treatment of regional lymph nodes is the mainstay of current management strategies. For patients with clinically negative lymph nodes, sentinel lymph node biopsy and PET scans for patients with suspected pelvic node involvement has improved the diagnostic yield. The new neoadjuvant therapy (both chemotherapy and radiotherapy) has helped to downstage the disease for complete resection. The prognosis of scrotal SCC is determined by margin-free excision, depth of infiltration, and its histologic grade. Future trials focussing on the conjunction of SCC with penile cancer, as well as the creation of a multinational network for ‘virtual’ online multidisciplinary meetings, will help to improve the overall survival for scrotal SCC patients.