Scrotal Carcinoma Research Articles

Scrotal cancer, chimney sweepers and Sir Percival Pott

The 18th century was linked to a type of skin cancer with a clear professional etiology: scrotal carcinoma in chimney sweeps. Sir Percival Pott had the merit of identifying the disease as a malignant and inexorable process and of describing its natural evolution. In this article, we present some historical aspects of such description, as well as the working environment of the main individuals affected by this cancer, who were children carrying out the work of chimney sweeps.

Case report of scrotal sebaceous carcinoma with carcinoma‐in‐situ component in a 54 year old male patient

Case report of scrotal sebaceous carcinoma with carcinoma‐in‐situ component in a 54 year old male patient

Human papillomavirus 16 is an aetiological factor of scrotal cancer

Background:Squamous cell scrotal carcinoma (SCSC) is an infrequent skin cancer associated historically with occupational carcinogens. Human papillomavirus (HPV) DNA has been associated with SCSC but there is no definitive proof of its oncogenic role.Methods:Human papillomavirus-DNA and –E6*I mRNA were analysed in six invasive histologically typed SCSC. LCM-PCR was used to localise HPV DNA to tumour cells. P16INK4aand p53 expression were studied by immunohistochemistry.Results:In three warty or basaloid SCSC HPV16-DNA and E6*I-mRNA were detected. LCM-PCR confirmed HPV16 was in p16INK4a-positive malignant cells. However, of three usual-type SCSC, all were HPV-negative and two expressed p53 protein but not p16INK4a.Conclusions:Human papillomavirus 16 was present in tumour cells and oncogenically active in basaloid and warty SCSC, whereas usual SCSC was HPV-negative and showed immunostaining, suggesting p53 mutation. The dual pathways of oncogenesis and relation between histological type of SCSC and HPV are similar to that in penile cancers.

Carcinoma Scrotum- Two Case Reports and Review of Literature

Scrotal carcinoma is a rare tumor. We report two cases of this rare tumor. First case, a 40 year male, presented with a non-healing ulcer at the upper part of scrotum on right side, which did not respond to routine therapy. Patient had this ulcer for last five months. He had been a worker at automobile work-shop for last fifteen years and a chronic smoker for two decades. Scrotal skin was excised and sent for histopathology. It was reported to be as squamous cell carcinoma. This was likely due to a repeated occupational exposure outcome. Second case was of a 38 year male presented with a cauliflower like growth at the upper part of scrotum on right side, which did not respond to therapy. Patient had this growth for last eight months. He is a chronic smoker for last 25 years. He had no significant occupational history. The patient underwent fine needle aspiration cytology and was reported to be squamous cell carcinoma with marked tumor diathesis. After literature review, we conclude that scrotal carcinoma is currently a rare tumor, and even more in cases with occupational exposure to carcinogens. These case reports highlight the importance of proper history taking regarding occupation, smoking etc.

Squamous cell carcinoma of the scrotum - still an occupational hazard

Squamous cell carcinoma (SCC) of the scrotum was one of the first occupational diseases to be described, and acquired its eponym from Sir Percivall Pott. The condition has now become rare owing to the establishment of industrial health norms. A 45-year-old male with a history of long-term exposure to petrochemicals presented to our institution with a scrotal lesion and underwent wide-local excision of the same. Histopathology revealed well-differentiated SCC involving the epididymis. Treatment options included excision with ilio-inguinal bloc dissection (in the event of lymphadenopathy) with subsequent chemotherapy and/or radiotherapy. Tumors following occupational exposure thus continue to contribute to the rapidly decreasing incidence of scrotal carcinoma.

Carcinoma of the scrotum in a Young man with HIV Infection: Is there a Possible Association?

Squamous cell carcinoma of the scrotum is rare and its occurrences in the young is even rarer. A 39-year-old gentleman presented with a large non-healing ulcer developing on his left hemi-scrotum 9 months after the excisional biopsy of multiple pruritic nodular lesions on the scrotum. On histological examination it was found to be squamous cell carcinoma. Examination under anaesthesia revealed that the tumour was not resectable and patient was offered radiotherapy. Historically, scrotal carcinoma is occupation related, but none of the occupational predisposing factors was identified in this patient. Patient was however, found to be positive for HIV 1. We suggest that the occurrence of scrotal carcinoma which is normally seen in elderly men in a young man might be due to the associated HIV infection. NQJHM Vol. 16 (3) 2006: pp. 93-96

Scrotal neoplasia: would truck drivers be at greater risk?

To analyze how scrotal neoplasias have been managed during the past decade and to question possible factors or professions associated to its presence. We retrospectively evaluated every case reported from 1995 to 2005 at our hospital. We described the clinical scenario, complementary exams, treatments and outcomes. We also tried to verify if there was any risk, predisposing factors or professions that would explain the cancer origin. Six cases were reviewed. Out of these, three patients were truck drivers. Five of them showed restricted lesions without inguinal lymph nodes enlargement. Histologically, six patients presented squamous carcinoma, with two of them having the verrucous type. The median age of patients was 52 years old (31 to 89). The five patients who are still alive had their lesions completely removed with safety margin and primary closure. We have noticed that the scrotal carcinoma behavior is similar to that of the penis, where removal of the lesion and study of the regional lymph nodes help to increase the patient survival rate. The outstanding fact was that three out of six patients were truck drivers, raising the hypothesis that such profession, maybe due to the contact or attrition with the diesel exhaust expelled by the engine or to sexual promiscuity, would imply in a larger risk of developing this rare neoplasia.

A Case Of Scrotal Cancer With Inguinal Lymph Node Metastasis Treated By Multidisciplinary Modalities: A Case Report

In contrast to squamous cell carcinoma of the penis, scrotal carcinoma has historically been a disease of chimney sweeps, associated with exposure to environmental or industrial carcinogens and has only rarely been correlated with human papillomavirus. [1] We report on a former construction worker with squamous cell carcinoma of the scrotum who presented with associated extensive genital warts, suggesting a causal role of human papillomavirus in the development of squamous cell carcinoma of the scrotum. Other notable features in this case included fungating inguinal lymph node metastasis and successful treated by multidisciplinary modalities including staged surgical excision and radiotherapy. The patient was disease free at 28 months.

Verrucous scrotal carcinoma in a patient with hypospadias: is there a possible association?

We report a case of a locally advanced verrucous scrotal cancer in a patient with hypospadias. Surgical excision was performed and no recurrence was noted with 14 months of follow-up. To our knowledge, this association has not been reported. Historically, scrotal carcinoma is occupation related, but none of the occupational predisposing factors was identified in this patient. This observation suggests that hypospadias and secondary chronic inflammation of the scrotal skin, caused by prolonged contact with urine, may contribute to an increased risk of verrucous carcinoma.

Cumulation of TP53 Mutations and p16INK4A/ p15INK4B Homozygous Deletions in Human Papilloma Virus Type 16 Positive Scrotal Cancer

Scrotal cancer is the first described occupational cancer. The frequency of occupation-related scrotal cancer is very rare because of better hygiene and protective clothing. Human papilloma viruses (oncogenic types 16 and 18) were reported as the causative agents in the pathogenesis of scrotal cancers. E5, E6, and E7 proteins, expressed by human papilloma virus type 16, affect the cell cycle at the G1 checkpoint. TP53, p16 INK4A , and p15 INK4B were reported as the transcription factors that regulate the cell cycle on the same pathway. Here, the mutation pattern of TP53, p16 INK4A , and p15 INK4B genes and the homo/hemizygous deletion patterns of p16 INK4A /p15 INK4B genes are presented in four scrotal carcinoma cases. The results were correlated with the findings of oncogenic human papilloma viruses (types 16 and 18) in this panel. In two of four case, human papilloma virus type 16 was observed. Homozygous deletion in p16 INK4A /p15 INK4B genes and a codon 259 missense point mutation (GAC →TAC; Asp →Tyr) in the TP53 gene were observed in one human papilloma positive scrotal carcinoma case. The homozygous deletion in p16 INK4A /p15 INK4B genes was observed in another human papilloma positive scrotal carcinoma case. The cumulation of TP53 mutations and p16 INK4A /p15 INK4B homozygous deletions in human papilloma virus type 16 positive scrotal carcinoma cases indicate that the alterations of TP53, p16 INK4A , and p15 INK4B genes have an important role in the progression of scrotal cancers, as well as other factors. The survival rate for the two human papilloma virus type 16 positive patients who had a TP53 mutation or p16 INK4A /p15 INK4B homozygous deletion or both was lower than that for the human papilloma virus type 16 negative cases who had no TP53, p16 INK4A , and p15 INK4B mutation. The molecular alteration of TP53, p16 INK4A , and p15 INK4B genes may be useful as a prognostic marker in scrotal cancer.

Development of Human Papillomavirus Type 16 Associated Squamous Cell Carcinoma of the Scrotum in a Patient with Darier's Disease Treated with Systemic Isotretinoin

In contrast to squamous cell carcinoma of the penis, scrotal carcinoma has historically been associated with exposure to environmental or industrial carcinogens and has only rarely been correlated with human papillomavirus. We report on a patient with squamous cell carcinoma of the scrotum in which human papillomavirus type 16 was integrated into the tumor cell genome, suggesting a causal role of human papillomavirus in the development of squamous cell carcinoma of the scrotum. Other unique features of our case include the presence of Darier's disease, an uncommon genodermatosis, and treatment with oral retinoids, which have prophylactic value in the prevention of cutaneous malignancies.

Inguinal and Pelvic Lymphadenectomy for Penile Cancer

Lymphatic vessels are composed of an endothelial layer surrounded by connective tissue containing scattered muscular and elastic elements. They develop in close relationship and usually follow venous structures. Together with the lymph nodes, they are the first regional barrier against malignant tumor spread. For over a century surgeons have recognized the need for and have recommended groin lymphadenectomy in patients with scrotal carcinoma: melanoma of the e~tremity:~ penile cancer:’ and vulvar carcinoma.45 Today groin dissections are indicated for malignant metastatic disease from the lower extremity, the umbilicus, the perineum and pericrural areas, the buttocks, and the external genitalia.55 Groin lymphadenectomy in combination with complete removal of the primary tumor appears to have a major therapeutic role in the management of some patients with penile, scrotal, and distal urethral carcinoma. This article discusses the regional anatomy, indications, surgical technique, and recent modifications in performing groin lymphadenectomy, with special attention to carcinoma of the penis.

A population-based study of survival after scrotal carcinoma.

In previous reports on scrotal carcinomas, overall 5-year survival rates have varied from 18% to 70% without explanation. In this study, survival was determined through the active follow-up of the Connecticut Tumor Registry for 65 cases of scrotal carcinoma diagnosed in the state from 1935 to 1980. The overall actuarial probability of surviving 5 years was 0.57. Stage and age at diagnosis were statistically significant predictors of survival (P less than 0.001 and P = 0.016, respectively). Survival varied progressively with combinations of these two variables with subjects younger than age 65 years and localized at diagnosis having 5-year survival of 0.75, compared to 0.17 for subjects age 65 years and older with regional or distant spread; these survival outcomes encompassed those of previous reports. With the passage of more than four decades, no improvement in survival was detectable. Initial radiotherapy, given to nine cases, also bore no detectable relationship to survival after adjustment for other variables. The 30 men in metalworking occupations previously shown to be associated with this cancer were not more frequently diagnosed with the cancer in localized stage, and showed a survival similar to that for the 29 men in other occupations.

Scrotal carcinoma in Connecticut metalworkers: sequel to a study of sinonasal cancer.

An excess risk for sinonasal cancer among Connecticut metalworkers with potential exposure to cutting oils led to the hypothesis of a relationship between the same occupational category and squamous cell carcinoma of the scrotum. Cases of this latter tumor (n = 45) diagnosed in 1935-1973 were identified by the Connecticut Tumor Registry. For decedents, male controls from Connecticut death certificates were matched to decedent cases on age, year of birth, and availability of occupational information; for living subjects, male controls from records of the Connecticut Department of Motor Vehicles were matched on the above variables and town of residence. Death certificates and city directories provided occupational information. For the narrowly defined indicator of cutting oil exposure (toolmaker, setter, set-up man, hardener, polisher, automatic screw machine operator), the odds ratio for squamous cell carcinoma of the scrotum was 4.9, 95% confidence limits (CL): 1.8, 15.9. The broad indicator of cutting oil exposure (not otherwise specified) categories plus machinist and machine operator (not otherwise specified) had an odds ratio of 10.5, 95% CL: 4.0, 36.9 and explained 57% of the cancers. For this broad category, the risk persisted in the most recent time period of diagnosis, 1966-1973 (OR = 18.6). For this broad category, major biases could not be detected when the following additional covariables were taken into account individually where possible: source of occupation, nativity, town of residence, stage at diagnosis, and cause of death. City directory and death certificate information implied that at least 80% of cases in the high risk category worked in the Connecticut region before age 40.

Carcinoma of scrotum

Twelve patients with carcinoma of the scrotum were evaluated: 9 with squamous carcinoma and 3 with basal cell carcinoma. The presenting complaint was a visible skin lesion; the interval between awareness of this lesion and diagnosis averaged 3.3 years. Three of the 12 patients were black, although this disease previously has been considered rare in blacks. No occupation predominated among the patients in this series, and scrotal carcinoma today may occur as a result of nonspecific factors such as poor hygiene and chronic irritation, rather than industrial exposure. Only 5 of 12 patients were disease free after treatment; 5 of the others died of squamous carcinoma, 1 died of a postoperative complication, and 1 was lost to follow-up. The most significant correlative with survival was stage at initial diagnosis, indicating the need for a high index of suspicion regarding lesions of the scrotum.

Experience With Carcinoma Of The Scrotum

The natural history, management and prognosis of scrotal carcinoma are reviewed in 19 cases and a method to stage the tumor is presented. Ten patients were rendered free of evidence of cancer, 9 of whom have survived more than 5 years. Wide local excision of the primary lesion with radical ilioinguinal dissection for proved inguinal lymph node metastases is the present recommendation. For non-resectable regional metastatic disease no treatment of established effectiveness is available. Irradiation has produced benefit on rare occasions and hemipelvectomy may be considered in selected cases.

Carcinoma of the scrotum.

Past occupational factors are shown to be important in four out of five cases of scrotal carcinoma registered in a recent two-year period. Protection from mineral oils in present-day industry must remain efficient to prevent further carcinogenesis. The principles of protection are discussed.

Dermatoses in jute workers.

Although skin changes in workers associated with the manufacture of various textiles, especially cotton, have been the subject of numerous com munications (e.g., Southam, 1927 ; Brockbank, 1941) there are few references in the literature to dermatoses in jute workers. Henry (1947) refers to one case of scrotal carcinoma in a jute worker out of a total of 1,421 notifications to the Factory Inspectorate. Even the standard textbooks on occupational diseases of the skin (Schwartz, Tulip?n, and Peck, 1947 ; Prosser White, 1934) contain little information on this subject, and a paper on jute dermatitis in Indian workers (Curjel and Acton, 1924) describes only the follicular lesions of oil acne. There has not been, to our knowledge, any com prehensive survey of skin changes in jute workers. One of us (J. K.) had noted certain changes on the exposed skin of elderly jute workers, and since the major part of jute manufacture in Britain is con centrated in or around Dundee, it seemed that a planned survey in this region would fill a gap in our knowledge and produce results of some value. This study only refers to skin changes which may be associated with the manufacture of jute from its raw state as received in this country to the finished woven article. The principal difference between the manufacture of jute and that of most other fibres is that jute has to be treated with a mixture or emulsion of oil and water before it can be spun ; the jute worker therefore is exposed to an unnaturally oily fibre in addition to any contact with oil used in lubricating the machinery. Up till about 25 years ago whale oil was used but since then varying proportions of mineral oil have been added and whale oil has been used less and less until the recent war years when its scarcity and high price stopped its use altogether. The oil is added to the jute fibre in the first stage of manufacture (known as batching ) when it is softened between rollers. It is then prepared by a carding process similar to that used in the cotton and woollen industry ; the sliver ribbon then goes through the drawing department in which it is thinned and elongated and is then twisted on to bobbins ready for spinning. Jute spinning, unlike cotton spinning, is done on frames with spindles revolving at the high speed of some 4,000 revolutions per minute. The spun yarn is wound either for the warp ( spool-winding ) or for the weft ( cop-winding ) and the beamers make the warp thread ready for the weavers. Woven jute is coarse material, used for a variety of purposes such as sacks or backing for linoleum. The woven cloth may be taken to the sewing flat for conversion into sacks or to the calender where it is folded, rot-proofed if need be, and otherwise prepared for the market. In one establishment we visited there was a tar house in which jute yarn was coated with tar for a special purpose. Terms used for other workers are self explanatory. All had contact with jute except the office and canteen staffs. Our investigation was divided into two main parts : (1) a clinical survey covering a period of one year (July, 1952 to August, 1953) of all new patients over the age of 16 attending the ordinary skin out patients clinic of Dundee Royal Infirmary, the only centre for such clinics in the city ; and (2) a field survey of all workers in seven jute mills and factories in the city.

Malignancy in the Skin

Epithelioma of the skin (basal and squamous cell) is eminently curable by radiation, the prognosis being much poorer when glandular metastasis has occurred. Radiation must be adequate (at least 6,000 r for squamous cell, less for basal cell), and the growing edge is all important. In post-irradiation cancer, any further irradiation is contra-indicated, and even the use of “ultra-violet rays” must be guarded. For scrotal carcinoma, surgery is the method of choice, with radiation as adjuvant.