Treatment of Penoscrotal Basal Cell Carcinoma – An Institutional Retrospective Review

Treatment of Penoscrotal Basal Cell Carcinoma – An Institutional Retrospective Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Treatment of Penoscrotal Basal Cell Carcinoma – An Institutional Retrospective Review Jeremy G. Light, Genevieve Muñoz, M. Laurin Council This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2675549/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Basal cell carcinoma (BCC) of the sun-protected genital region is rare. We examined all penoscrotal BCC at a single institution over an 18-year period. A total of 7 cases were identified, 5 scrotal and 2 penile. Four cases (57%) were treated with Mohs micrographic surgery (MMS) and 3 cases (43%) with conventional excision. A prior retrospective review of vulvar BCC at our institution during the same time period showed that MMS was utilized in 4 (11%) of 35 cases. Functional preservation is vital when performing surgery on the genitals and tissue-sparing MMS provides optimal tumor clearance and outcomes for both males and females. Basal cell carcinoma penis scrotum vulva genital Mohs micrographic surgery recurrence Figures Figure 1 Background Basal cell carcinoma (BCC) occurring in the genital region is rare, comprising less than 1% of all BCCs [ 1 ]. We examined the treatment and recurrence rate of basal cell carcinoma (BCC) of the penis and scrotum at our institution over an 18-year period. Methods A retrospective review of all patients who underwent treatment of biopsy-proven BCC of the penis and scrotum at Washington University was performed. A query was submitted to CoPath, our institutional pathology database, between the years 2000–2018 for the search terms “basal cell carcinoma” and “penis, penile shaft, corona, prepuce, foreskin, glans, scrotum, raphe.” All resulting records were reviewed for relevancy based on tumor type and location. Information collected included age, race, histologic subtype, immune status, treatment, and recurrence. Recurrence was determined using documented skin examinations and confirmed by biopsy. This study was approved by the Institutional Review Board at the Washington University School of Medicine in Saint Louis. Results A total of 7 cases of BCC of the penis and scrotum were identified between the years 2000 and 2018. The mean age at diagnosis was 70 years, ranging from 55 to 80. Five cases were located on the scrotum (71%) and 2 on the penis. Most patients were Caucasian (86%) and one African American. One patient was a renal transplant recipient and the only case of immunosuppression. (Table 1 ) Table 1 Characteristics, Management, and Outcomes of Penoscrotal Basal Cell Carcinoma Between 2000 and 2018. MMS, Mohs micrographic surgery. Location Tumor size (cm 2 ) Treatment Recurrence (Y/N) Immunosuppression (Y/N) Scrotum 1.20 Excision N N Penis 1.05 Excision N N Scrotum 0.35 Excision Y N Scrotum 0.40 MMS N N Scrotum 0.36 MMS N N Scrotum 1.92 MMS N N Penis 0.63 MMS N Y Four cases (57%) were treated with Mohs micrographic surgery (MMS), the remaining 3 cases were treated with surgical excision (43%). The average tumor size was 0.84 cm 2 . Histological subtypes were not specified for all cases; however, 2 were infiltrative (29%) and 1 pigmented (14%). One conventional excision reported 5 mm margins, the other two did not report surgical margins. Most surgical defects were repaired with linear closures except two cases treated with MMS healed by secondary intention. One case treated with conventional excision had BCC present at the surgical margin and subsequently treated with repeat excision. There was one case of tumor recurrence following conventional excision on the scrotum (Fig. 1 ). The average follow up time after treatment was 43 months. Follow up was defined as having a skin examination by a dermatologist or treating physician. Five cases were identified and treated by dermatology, 4 treated with MMS and 1 excision. Two cases were identified by urology resulting in 2 excisions, one requiring a repeat excision by general surgery. Discussion Surgical management of male genital skin cancer has traditionally been conventional excision of the scrotum and total or partial amputation of the penis [ 2 , 3 ]. This surgical approach has high rates of positive margins (45%) and local recurrence (12.5%) for scrotal cancers [ 4 ]. Penectomy has low local recurrence (3–10%) at the expense of disfigurement causing functional and psychosocial impairment [ 4 ]. Organ-sparing conventional excision improves function and quality of life but with higher rates of positive margins (19.2%) and local recurrence (6.0–34%) [ 4 ]. Mohs micrographic surgery (MMS) for male genital skin cancer is an organ-sparing technique with low local recurrence rates (0.84-11%) and high patient reported satisfaction [ 4 ]. Reported outcomes for male genital skin cancer treatments are predominantly from squamous cell carcinoma due to far higher incidence. BCC of the genital region is primarily reported in case reports and series, limiting the availability of specific local recurrence rates and patient outcomes. A recently published population-based study of genital BCC which included 1,607 cases found a female to male ratio of 5.3 with the most common location being the labia majus and scrotum. [ 1 ]. BCC located on the scrotum was 3 times more common than the penis [ 1 ]. A retrospective review at our institution of vulvar BCC during the same time period was recently published [ 5 ] (Table 2 ). MMS was less frequently utilized in treating BCC of the vulva (11%) compared to penoscrotal (57%). Most vulvar BCCs were identified and treated by gynecology with either wide local excision (46%) or vulvectomy (37%). Tumors treated with vulvectomy were only slightly larger than those treated with wide local excision (1.54 v. 0.94 cm 2 ) [ 5 ]. The tendency for a more radical surgical approach when treating genital BCC in females warrants further investigation. One possibility is that females are more likely to present to gynecology and managed without involvement of dermatology. Table 2 Location and Treatment of Vulvar Basal Cell Carcinoma Between 2000 and 2018. MMS, Mohs micrographic surgery; EDC, Electrodessication and curettage. Vulvar Basal Cell Carcinoma Location (n, 35) Labia majus 28 (80%) Suprapubic 6 (17%) Clitoris 1 (3%) Treatment Wide local excision 16 (46%) Vulvectomy 13 (37%) MMS 4 (11%) EDC 2 (6%) National comprehensive cancer network guidelines state that MMS is indicated for the surgical treatment of BCC of the genitals regardless of tumor size or risk stratification [ 6 ]. Functional preservation is paramount for patients undergoing surgical treatment of the genitals. Patients with genital BCC often present to a variety of subspecialty clinics including urology, gynecology, surgery, and dermatology. Therefore, a multidisciplinary approach and communication across specialties can increase patient access to tissue-sparing MMS, providing optimal tumor clearance and functional urinary and sexual outcomes for both males and females. Declarations Funding source: none Disclosures: The authors have no conflicts to disclose. References Chen X, Hou Y, Chen C, Jiang G. Basal Cell Carcinoma of the External Genitalia: A Population-Based Analysis. Front Oncol . 2021 Jan 26;10:613533. Huang JH, Broggi M, Osunkoya AO, Master VA. Surgical management of primary scrotal cancer. Urol Clin North Am . 2016 43(4):531–544. Campbell RA, Slopnick EA, Ferry EK, Zhu H, Kim SP, Abouassaly R. Disparity between pre-existing management of penile cancer and NCCN guidelines. Urol Oncol . 2017 35(8):531.e9-531.e14. Lukowiak TM, Perz AM, Aizman L, et al. Mohs micrographic surgery for male genital tumors: Local recurrence rates and patient-reported outcomes. J Am Acad Dermatol . 2021 Apr;84(4):1030–1036. Muñoz G, Singla P, Hurst E, Council LM. Clinical Characteristics of Basal Cell Carcinomas of the Vulva: An Institutional Retrospective Review. Derm Surg. 2023 Jan 1;49(1):13–16. NCCN Clinical Practice Guidelines in Oncology: Basal Cell Skin Cancer. Version 2.2022. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 27 Mar, 2023 Reviewers agreed at journal 27 Mar, 2023 Reviewers invited by journal 26 Mar, 2023 Submission checks completed at journal 11 Mar, 2023 Editor assigned by journal 11 Mar, 2023 First submitted to journal 09 Mar, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2675549","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":182590551,"identity":"feb006ac-b75d-4a32-ae83-e561f28931e4","order_by":0,"name":"Jeremy G. Light","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5klEQVRIie2RsQrCMBCGIwfpcuAaQeorVAJFUPBV0qVTOriLVALp5uxjODkLRac+QPeCgy5CQZzUBkVwMR0d8nHDf3AfdyGEOBx/SCfrpEDIBLsAu6ZnfbuijCJiv5dpYRS0rwFTIudBUQSmtyugQJ1nN4jSUtancj5C4uX7jeUwPV4LGi3XyXYsD81hGMelTeEoMFIs2XJJG4Vh2EZhkWbyyOW9naIqFAFHLKBKdMstgLHwmadDSFYMqe0twyyrapw8cJpDVcvrwu96+eG3khLK3vkV6K9xw6D5mss7f4LD4XA4vngC12hEtvbWqVYAAAAASUVORK5CYII=","orcid":"","institution":"Washington University in St. Louis","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Jeremy","middleName":"G.","lastName":"Light","suffix":""},{"id":182590553,"identity":"82c15cee-b8d9-43a6-a14c-fe32ccde540e","order_by":1,"name":"Genevieve Muñoz","email":"","orcid":"","institution":"Washington University in St. Louis","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Genevieve","middleName":"","lastName":"Muñoz","suffix":""},{"id":182590554,"identity":"9b8d577f-5f00-4c8c-b59f-5926fcb0ee3f","order_by":2,"name":"M. Laurin Council","email":"","orcid":"","institution":"Washington University in St. Louis","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"M.","middleName":"Laurin","lastName":"Council","suffix":""}],"badges":[],"createdAt":"2023-03-09 23:29:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2675549/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2675549/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":34358048,"identity":"4f5bcaef-e2cf-48eb-99ca-fb42a2c4cb8f","added_by":"auto","created_at":"2023-03-16 14:19:43","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":937036,"visible":true,"origin":"","legend":"\u003cp\u003e(A) Pink shiny eroded plaque with rolled borders on the scrotum. (B) Histological image demonstrating aggregates of basaloid cells within the dermis with peripheral palisading (H\u0026amp;E, 4X).\u003c/p\u003e","description":"","filename":"PenscrotalBCCFigure.png","url":"https://assets-eu.researchsquare.com/files/rs-2675549/v1/b4f32091e2e1eaef26f97372.png"},{"id":34358050,"identity":"ce0a757d-3bd6-4fbb-88bd-b66bfa51253b","added_by":"auto","created_at":"2023-03-16 14:19:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":986228,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2675549/v1/3394224e-1f37-473d-897e-687e6c06ce83.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Treatment of Penoscrotal Basal Cell Carcinoma – An Institutional Retrospective Review","fulltext":[{"header":"Background","content":"\u003cp\u003eBasal cell carcinoma (BCC) occurring in the genital region is rare, comprising less than 1% of all BCCs [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. We examined the treatment and recurrence rate of basal cell carcinoma (BCC) of the penis and scrotum at our institution over an 18-year period.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA retrospective review of all patients who underwent treatment of biopsy-proven BCC of the penis and scrotum at Washington University was performed. A query was submitted to CoPath, our institutional pathology database, between the years 2000\u0026ndash;2018 for the search terms \u0026ldquo;basal cell carcinoma\u0026rdquo; and \u0026ldquo;penis, penile shaft, corona, prepuce, foreskin, glans, scrotum, raphe.\u0026rdquo; All resulting records were reviewed for relevancy based on tumor type and location. Information collected included age, race, histologic subtype, immune status, treatment, and recurrence. Recurrence was determined using documented skin examinations and confirmed by biopsy. This study was approved by the Institutional Review Board at the Washington University School of Medicine in Saint Louis.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 7 cases of BCC of the penis and scrotum were identified between the years 2000 and 2018. The mean age at diagnosis was 70 years, ranging from 55 to 80. Five cases were located on the scrotum (71%) and 2 on the penis. Most patients were Caucasian (86%) and one African American. One patient was a renal transplant recipient and the only case of immunosuppression. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics, Management, and Outcomes of Penoscrotal Basal Cell Carcinoma Between 2000 and 2018. MMS, Mohs micrographic surgery.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTumor size (cm\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTreatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRecurrence (Y/N)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eImmunosuppression (Y/N)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScrotum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExcision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePenis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExcision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScrotum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExcision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScrotum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMMS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScrotum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMMS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScrotum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMMS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePenis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMMS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFour cases (57%) were treated with Mohs micrographic surgery (MMS), the remaining 3 cases were treated with surgical excision (43%). The average tumor size was 0.84 cm\u003csup\u003e2\u003c/sup\u003e. Histological subtypes were not specified for all cases; however, 2 were infiltrative (29%) and 1 pigmented (14%). One conventional excision reported 5 mm margins, the other two did not report surgical margins. Most surgical defects were repaired with linear closures except two cases treated with MMS healed by secondary intention.\u003c/p\u003e \u003cp\u003eOne case treated with conventional excision had BCC present at the surgical margin and subsequently treated with repeat excision. There was one case of tumor recurrence following conventional excision on the scrotum (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The average follow up time after treatment was 43 months. Follow up was defined as having a skin examination by a dermatologist or treating physician.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFive cases were identified and treated by dermatology, 4 treated with MMS and 1 excision. Two cases were identified by urology resulting in 2 excisions, one requiring a repeat excision by general surgery.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eSurgical management of male genital skin cancer has traditionally been conventional excision of the scrotum and total or partial amputation of the penis [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This surgical approach has high rates of positive margins (45%) and local recurrence (12.5%) for scrotal cancers [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Penectomy has low local recurrence (3\u0026ndash;10%) at the expense of disfigurement causing functional and psychosocial impairment [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Organ-sparing conventional excision improves function and quality of life but with higher rates of positive margins (19.2%) and local recurrence (6.0\u0026ndash;34%) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Mohs micrographic surgery (MMS) for male genital skin cancer is an organ-sparing technique with low local recurrence rates (0.84-11%) and high patient reported satisfaction [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eReported outcomes for male genital skin cancer treatments are predominantly from squamous cell carcinoma due to far higher incidence. BCC of the genital region is primarily reported in case reports and series, limiting the availability of specific local recurrence rates and patient outcomes. A recently published population-based study of genital BCC which included 1,607 cases found a female to male ratio of 5.3 with the most common location being the labia majus and scrotum. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. BCC located on the scrotum was 3 times more common than the penis [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA retrospective review at our institution of vulvar BCC during the same time period was recently published [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). MMS was less frequently utilized in treating BCC of the vulva (11%) compared to penoscrotal (57%). Most vulvar BCCs were identified and treated by gynecology with either wide local excision (46%) or vulvectomy (37%). Tumors treated with vulvectomy were only slightly larger than those treated with wide local excision (1.54 v. 0.94 cm\u003csup\u003e2\u003c/sup\u003e) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The tendency for a more radical surgical approach when treating genital BCC in females warrants further investigation. One possibility is that females are more likely to present to gynecology and managed without involvement of dermatology.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLocation and Treatment of Vulvar Basal Cell Carcinoma Between 2000 and 2018. MMS, Mohs micrographic surgery; EDC, Electrodessication and curettage.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVulvar Basal Cell Carcinoma\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLocation (n, 35)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLabia majus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (80%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuprapubic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (17%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClitoris\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTreatment\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWide local excision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (46%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVulvectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (37%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMMS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (11%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEDC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNational comprehensive cancer network guidelines state that MMS is indicated for the surgical treatment of BCC of the genitals regardless of tumor size or risk stratification [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Functional preservation is paramount for patients undergoing surgical treatment of the genitals. Patients with genital BCC often present to a variety of subspecialty clinics including urology, gynecology, surgery, and dermatology. Therefore, a multidisciplinary approach and communication across specialties can increase patient access to tissue-sparing MMS, providing optimal tumor clearance and functional urinary and sexual outcomes for both males and females.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eFunding source: none\u003c/p\u003e\n\u003cp\u003eDisclosures:\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts to disclose.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChen X, Hou Y, Chen C, Jiang G. Basal Cell Carcinoma of the External Genitalia: A Population-Based Analysis. \u003cem\u003eFront Oncol\u003c/em\u003e. 2021 Jan 26;10:613533.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang JH, Broggi M, Osunkoya AO, Master VA. Surgical management of primary scrotal cancer. \u003cem\u003eUrol Clin North Am\u003c/em\u003e. 2016 43(4):531\u0026ndash;544.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCampbell RA, Slopnick EA, Ferry EK, Zhu H, Kim SP, Abouassaly R. Disparity between pre-existing management of penile cancer and NCCN guidelines. \u003cem\u003eUrol Oncol\u003c/em\u003e. 2017 35(8):531.e9-531.e14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLukowiak TM, Perz AM, Aizman L, et al. Mohs micrographic surgery for male genital tumors: Local recurrence rates and patient-reported outcomes. \u003cem\u003eJ Am Acad Dermatol\u003c/em\u003e. 2021 Apr;84(4):1030\u0026ndash;1036.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMu\u0026ntilde;oz G, Singla P, Hurst E, Council LM. Clinical Characteristics of Basal Cell Carcinomas of the Vulva: An Institutional Retrospective Review. \u003cem\u003eDerm Surg.\u003c/em\u003e 2023 Jan 1;49(1):13\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNCCN Clinical Practice Guidelines in Oncology: Basal Cell Skin Cancer. Version 2.2022.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-dermatological-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Archives of Dermatological Research](https://www.springer.com/journal/403)","snPcode":"403","submissionUrl":"https://submission.nature.com/new-submission/403/3","title":"Archives of Dermatological Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Basal cell carcinoma, penis, scrotum, vulva, genital, Mohs micrographic surgery, recurrence","lastPublishedDoi":"10.21203/rs.3.rs-2675549/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2675549/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBasal cell carcinoma (BCC) of the sun-protected genital region is rare. We examined all penoscrotal BCC at a single institution over an 18-year period. A total of 7 cases were identified, 5 scrotal and 2 penile. Four cases (57%) were treated with Mohs micrographic surgery (MMS) and 3 cases (43%) with conventional excision. A prior retrospective review of vulvar BCC at our institution during the same time period showed that MMS was utilized in 4 (11%) of 35 cases. Functional preservation is vital when performing surgery on the genitals and tissue-sparing MMS provides optimal tumor clearance and outcomes for both males and females.\u003c/p\u003e","manuscriptTitle":"Treatment of Penoscrotal Basal Cell Carcinoma – An Institutional Retrospective Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-03-16 14:19:38","doi":"10.21203/rs.3.rs-2675549/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2023-03-27T18:16:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"2570d6d2-add8-4e68-bf66-0311b0bc0adf","date":"2023-03-27T18:15:03+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-03-26T23:45:41+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-03-11T06:05:34+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-03-11T06:05:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Dermatological Research","date":"2023-03-09T23:20:49+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-dermatological-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Archives of Dermatological Research](https://www.springer.com/journal/403)","snPcode":"403","submissionUrl":"https://submission.nature.com/new-submission/403/3","title":"Archives of Dermatological Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"13f28da6-62bc-4f7e-9423-ac24bd7148fb","owner":[],"postedDate":"March 16th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2023-03-30T23:29:17+00:00","versionOfRecord":[],"versionCreatedAt":"2023-03-16 14:19:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2675549","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2675549","identity":"rs-2675549","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}