Cutaneous scrotal metastasis: origins and clinical characteristics of visceral malignancies that metastasize to the scrotum

Abstract

Cutaneous metastases occur in about 10% of patients with cancer, occasionally presenting as the initial sign of internal malignancy. Most often cutaneous metastases are an indicator of advanced cancer and are associated with a poor prognosis. The scrotum is a rare site of cutaneous metastasis, and metastatic tumor to the scrotum can be mistaken for other skin lesions. We reviewed the published literature regarding patients who developed cutaneous metastasis to the scrotum. We summarized the clinical characteristics of these men, including primary tumor sites, age at diagnosis, treatment regimens, interval between diagnosis of primary tumor and subsequent metastasis, and outcomes. We extensively searched the PubMed medical database for papers on visceral malignancies with metastasis to the scrotum. We limited our definition to solid organ tumors; thus lymphomas, sarcomas, and melanomas of the scrotum were excluded. We identified 29 patients who developed scrotal metastases from visceral cancers. The colon/rectum (34%), prostate (28%), and lung (14%) were the most frequent sites of tumor origin. The prognosis for these patients is poor: mean patient survival was only four months after diagnosis of metastatic skin lesions. Cutaneous metastasis to the scrotum is a rare manifestation of internal malignancies that most often represents an advanced and/or progressive cancer associated with a poor prognosis. Treatment is often unsuccessful, and the mean patient survival following scrotal metastasis is <4 months.

Metastatic pancreatic adenocarcinoma to the scrotum

“…[3] Furthermore, histologic pathology of punch biopsies of the scrotum in our patient revealed metastatic adenocarcinoma consistent with the primary source. As per prior studies [2,3] , histological findings most frequently revealed adenocarcinoma at site of cutaneous metastasis. This may be suggestive that adenocarcinomatous lesions have a more favorable predilection in travel to skin.…”

“…Cutaneous nodules were found to be the most frequent manifestation (19 of 29 men) of scrotal metastases. [2] Our patient presented with generalized induration, highlighting the morphological variability of metastatic cutaneous lesions. Our patient's generalize induration and edema mimics that of an inflammatory reaction.…”

“…Of the 29 cases of scrotal metastasis reported [2] , they most commonly (13 of 29) originated from the urogenital tract (encompassing origins in the prostate, bladder, kidney, and urethra). This is consistent with reports that cutaneous manifestations most frequently are reported at locations in the vicinity of the primary tumor.…”

“…Interestingly, in 20% of the patients described with scrotal metastases (6 of 29), the scrotal cutaneous lesions were the initial sign of internal malignancy or were identified within one month of diagnosis. [2] Also, in reviewing 22 cases of cutaneous metastatic pancreatic cancer, in 11 of the cases, the metastatic lesions to the skin were the first symptoms of pancreatic cancer. [1] The incidence of cutaneous metastatic manifestations of pancreatic cancer has been estimated at 2.0%, and the most frequent site of metastasis was the umbilicus, known as Sister Mary Joseph's nodule.…”

“…A recent review of cutaneous scrotal metastases by Hoyt et al [2] describes the 29 reported cases of solid organ visceral malignancies with metastasis to the scrotum. Of those with a primary malignancy of gastrointestinal origin, none were described from the pancreas.…”