Surgical pearl: pinch-punch excisions for scrotal calcinosis

Abstract

S crotal calcinosis is a rare condition that is characterized by the presence of a few, but more often multiple, firm, calcified papules and nodules on the scrotal skin, ranging in size from a few millimeters to several centimeters (Fig 1). The pathogenesis remains unclear and somewhat controversial. One side proposes that the nodules represent dystrophic calcification of epidermoid cysts,1 eccrine duct milia,2 eccrine epithelial cysts,3 whereas the other side proposes that they are truly idiopathic.4 The scrotal nodules usually appear during early adulthood. Most lesions are asymptomatic; however, itching, secondary infection, and draining chalky white material may develop that can be very annoying. Removal of these lesions is often warranted, because these usually increase in number and size. Occasionally, surgical reconstruction for massive deformity of the scrotum is required.5 Patients with this condition often feel embarrassed about their appearance, driving them to ask for surgical removal of these nodules for cosmetic purposes. However, removing these numerous lesions one by one is time-consuming and incision with classic fusiform design will leave relatively long scars. Furthermore, it is difficult to maintain skin tension during performance of elliptical excisions on scrotal skin, especially without assistance. A minimal incision technique has been described for removing epidermoid cysts and steatocystoma multiplex.6,7 Cyst contents are delivered by applying pressure to the base of the cysts. Any residual capsule material is removed with a forceps. We describe a novel pinchand-punch excision technique for removing scrotal calcinosis that is quick, simple, and yields an excellent surgical outcome.