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Demirci MA, Wan L, Park A, Khachemoune A. A systematic review of basal cell carcinoma on the scrotum-reviewing presentation and identifying challenges in management. Arch Dermatol Res 2024; 316:255. [PMID: 38795216 DOI: 10.1007/s00403-024-03058-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 04/15/2024] [Accepted: 04/26/2024] [Indexed: 05/27/2024]
Abstract
Since the scrotum is rarely exposed to sunlight, basal cell carcinoma (BCC) development in this area is an uncommon occurrence. As result, there is a scarcity of research covering this particular presentation, which poses a diagnostic and therapeutic challenge for clinicians. The objective of this systematic review is to provide a thorough overview of scrotal BCC, including a summary of its clinical characteristics, and microscopic subtypes. It also seeks to discuss the many techniques used in the management of this uncommon clinical presentation. Utilizing data from 1957 to October 2023, a systematic review of PubMed and Wiley Online Library was conducted to identify all cases of scrotal BCC with various presentations and managements. A total of 73 patients were included. The median patient age was 65.9 years (range 42 to 87). All studies were either case reports or case series. Our review shows that treatment with Mohs micrographic surgery (MMS), leads to a superior patient outcome based on anecdotal evidence in select cases. To deepen our understanding of Mohs surgery's efficacy in treating scrotal BCC, it is imperative to conduct more robust research in the form of randomized clinical trials.
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Affiliation(s)
| | - Leo Wan
- West Virginia School of Osteopathic Medicine, Lewisburg, WV, USA
| | - Aileen Park
- University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Amor Khachemoune
- Brooklyn Campus of the VA NY Harbor Healthcare System, 800 Poly Place, Brooklyn, NY, 11209, USA.
- Department of Dermatology, SUNY Downstate, 450 Clarkson Ave, Brooklyn, NY, USA.
- State University of New York Downstate and Veterans Affairs Medical Center, 800 Poly Pl, Brooklyn, NY, 11209, USA.
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Žulpaitė G, Žulpaitė R, Vėželis A. Scrotal squamous cell carcinoma: a case report. J Surg Case Rep 2023; 2023:rjad128. [PMID: 36974168 PMCID: PMC10039754 DOI: 10.1093/jscr/rjad128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/20/2023] [Indexed: 03/27/2023] Open
Abstract
Scrotal squamous cell carcinoma (SCC) is a rare condition that typically manifests in the sixth decade of life and usually presents as a painless, solitary nodule that slowly increases in size, ulcerates, and gets infected. The diagnosis is often delayed, as the majority of patients tend to avoid seeking medical help due to embarrassment. We present a 62-year-old male with a massive 8 cm ulcerating painless tumor in the scrotum. A patient underwent scrotal extirpation with bilateral orchofuniculectomy and diagnostic bilateral inguinal lymphadenectomy. Histopathology revealed a well-differentiated SCC of the scrotal skin. Ignorance, lack of self-awareness, knowledge about risk factors and aggravated access to healthcare facilities remain important reasons for late diagnosis.
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Affiliation(s)
- Giedrė Žulpaitė
- Correspondence address. Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania. E-mail:
| | - Rūta Žulpaitė
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
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3
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Roberson D, Chelluri R, Skokan AJ, Xia L, Heavner MG, Lukowiak T, Schwartz L, Lee DJ, Guzzo TJ, Kovach SJ, Miller C, Kovell RC. Outcomes of mohs microgrpahic resection for cutaneous malignancy involving the scrotum. Urol Oncol 2021; 39:501.e11-501.e16. [PMID: 34187750 DOI: 10.1016/j.urolonc.2021.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/11/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Squamous cell carcinoma (SCC) and extramammary Paget's Disease (EMPD) of the scrotum are exceedingly rare. Given their propensity for local invasion and treatment with wide local excision, they can be highly morbid conditions. Outcomes of Mohs Micrographic Surgery (MMS) for scrotal cutaneous malignancy is not well described in current literature. We hypothesized that MMS for scrotal cutaneous malignancy would provide equivalent or improved oncologic outcomes while limiting the morbidity associated with wide excision. MATERIALS/METHODS This is a retrospective review and analysis of a prospectively maintained database spanning entries from 2005 to 2019. Collected data included general patient characteristics and surgical characteristics reported on a per lesion basis. MMS was performed by our institution's department of dermatology using their standard technique. RESULTS Overall, a total of 26 consecutive patients with 28 lesions (SCC or EMPD) were analyzed. Out of our cohort of 15 patients with 16 scrotal SCC lesions, 10 (66%) patients were current or former smokers, 4 (26%) were immunosuppressed, and 2 (13%) had HPV infections. The median preoperative and postoperative size of SCC lesions were 5.7cm [2] and 20.2cm [2] respectively. There was one (6%) oncologic recurrence of SCC of the scrotum and one (6%) local wound complication. Our cohort also included 11 patients with 12 scrotal EMPD lesions. One patient (9%) had an underlying associated malignancy (prostate cancer). The preoperative and postoperative area of lesions were 50.6cm [2] and 96.4cm [2] respectively. One (9%) EMPD lesion had a positive final margin at resection requiring reoperation. After achieving negative surgical margins, no patients in this cohort had an oncologic recurrence. 3 (26%) scrotal EMPD cases had local wound postoperative complications, only one required reoperation. CONCLUSION To our knowledge, this is the first case series focused on MMS for both SCC and EMPD with scrotal involvement. Our data suggests that MMS for scrotal cutaneous malignancy may improve oncologic outcomes and may decreases local post-operative reconstructive issues when compared to reported outcomes of treatment with wide local excision. When able, scrotal cutaneous malignancy patients should be referred to urologists at centers with MMS capabilities as it likely will improve their outcomes. The urologist should maintain active involvement with these patients to coordinate this complex and advanced pattern of care.
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Affiliation(s)
- Daniel Roberson
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA.
| | - Raju Chelluri
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA
| | | | - Leilei Xia
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA
| | - Matthew G Heavner
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA
| | - Tess Lukowiak
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, PA
| | - Lauren Schwartz
- Department of Pathology, University of Pennsylvania Health System, Philadelphia, PA
| | - Daniel J Lee
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA
| | - Thomas J Guzzo
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA
| | - Stephen J Kovach
- Department of Plastic Surgery, University of Pennsylvania Health System, Philadelphia, PA
| | - Christopher Miller
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, PA
| | - R Caleb Kovell
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA
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Mitra A, Agarwal PN, Singh R, Verma S, Srivastava V, Chugh A, Jain V. Squamous cell carcinoma of the scrotum - still an occupational hazard. Indian J Occup Environ Med 2015; 18:150-2. [PMID: 25598622 PMCID: PMC4292202 DOI: 10.4103/0019-5278.146916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Aparajita Mitra
- Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - P N Agarwal
- Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Rajdeep Singh
- Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Sushant Verma
- Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Vaishali Srivastava
- Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Anmol Chugh
- Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Varun Jain
- Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
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Vyas R, Zargar H, Trolio RD, Lorenzo GD, Autorino R. Squamous cell carcinoma of the scrotum: A look beyond the chimneystacks. World J Clin Cases 2014; 2:654-660. [PMID: 25405188 PMCID: PMC4233419 DOI: 10.12998/wjcc.v2.i11.654] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/23/2014] [Accepted: 09/17/2014] [Indexed: 02/05/2023] Open
Abstract
Despite the low incidence, squamous cell carcinoma (SCC) remains the most common scrotal malignancy with a propensity for recurrence and metastasis. In recent years there has been a significant change in the epidemiology of scrotal SCC. Surgery is the mainstay of treatment for resectable disease. Sentinel lymph node dissection adapted from experience with penile SCC can reduce the morbidity of routine lymph node dissection. Emerging treatments for advanced and metastatic SCC are at the cusp of significantly changing management of this disease. We have performed a comprehensive review of scrotal SCC with a focus on these topics.
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Jianwei W, Libo M, Jianwei W, Liqun Z, Lihua G. Basal cell carcinoma of the scrotum with a lesion of 51 years' duration. Int J Dermatol 2011; 51:752-4. [PMID: 22171695 DOI: 10.1111/j.1365-4632.2010.04637.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Verhoeven RHA, Louwman WJ, Koldewijn EL, Demeyere TBJ, Coebergh JWW. Scrotal cancer: incidence, survival and second primary tumours in the Netherlands since 1989. Br J Cancer 2010; 103:1462-6. [PMID: 20877361 PMCID: PMC2990603 DOI: 10.1038/sj.bjc.6605914] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Since the 1970s there have been few epidemiological studies of scrotal cancer. We report on the descriptive epidemiology of scrotal cancer in the Netherlands. METHODS Data on all scrotal cancer patients were obtained from the Netherlands Cancer Registry (NCR) in the period 1989-2006 and age-standardised incidence rates were calculated also according to histology and stage. Relative survival was calculated and multiple primary tumours were studied. RESULTS The overall incidence rate varied around 1.5 per 1,000,000 person-years, most frequently being squamous cell carcinoma (27%), basal cell carcinoma (19%) and Bowen's disease (15%). Overall 5-year relative survival was 82%, being 77% and 95% for patients with squamous and basal cell carcinoma, respectively. In all, 18% of the patients were diagnosed with a second primary tumour. CONCLUSION The incidence rate of scrotal cancer did not decrease, although this was expected; affected patients might benefit from regular checkups for possible new cancers.
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Affiliation(s)
- R H A Verhoeven
- Department of Research, Eindhoven Cancer Registry, Comprehensive Cancer Centre South, PO Box 231, Eindhoven 5600 AE, The Netherlands.
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8
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Azike JE. A review of the history, epidemiology and treatment of squamous cell carcinoma of the scrotum. Rare Tumors 2009; 1:e17. [PMID: 21139888 PMCID: PMC2994436 DOI: 10.4081/rt.2009.e17] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2009] [Accepted: 07/12/2009] [Indexed: 11/22/2022] Open
Abstract
Squamous cell carcinoma of the scrotum is a tumor that is of interest for clinical and historical reasons. It was the first cancer linked to occupational exposure when, in 1775, Perivall Pott described it in chimney sweeps in England. Other occupations that had a preponderance of the disease included people who worked with the distillates of coal and men exposed to mineral oil. Currently, the disease is very rare and most cases are thought to result from poor hygiene and chronic irritation. Surgery with a negative resection margin offers the best hope of cure as adjunctive therapy has not proved useful. Prognosis correlates with the extent of nodal involvement.
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Affiliation(s)
- Jerome E Azike
- Department of Surgery, College of Medicine and Health Sciences, Imo State Universityœ, Orlu, Campus
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Chung SD, Huang KH, Lai YH, Huang CW, Tai HC, Chang SJ, Kuo YC. Synchronous advanced scrotal verrucous carcinoma with peripheral T-cell lymphoma. Urology 2007; 69:184.e5-7. [PMID: 17270651 DOI: 10.1016/j.urology.2006.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Revised: 08/23/2006] [Accepted: 10/05/2006] [Indexed: 10/23/2022]
Abstract
Scrotal verrucous carcinoma is extremely rare. Classic cases have been suggested to be occupation related. We report on a 65-year-old male drifter, who had concomitant multiple condyloma acuminatum and advanced verrucous carcinoma of the right hemiscrotal skin with peripheral T-cell lymphoma and extensive lymphadenopathy. To our knowledge, it is the first case of synchronous verrucous carcinoma and peripheral T-cell lymphoma. The patient died of disseminated disease 2 months after undergoing wide excision of the tumor. A brief discussion of the diagnosis, treatment, and prognosis is presented.
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Affiliation(s)
- Shiu-Dong Chung
- Department of Urology, Taipei City Hospital, Taipei, Taiwan, Republic of China.
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Pomara G, Pomara S, Travaglini F, Maras L, Selli C. Verrucous scrotal carcinoma in a patient with hypospadias: is there a possible association? Urology 2003; 61:224. [PMID: 12559309 DOI: 10.1016/s0090-4295(02)02095-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- G Pomara
- Urologia Universitaria Ospedale S. Chiara, Pisa, Italy
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Esquivias Gómez JI, González-López A, Velasco E, Pozo T, del Villar A. Basal cell carcinoma of the scrotum. Australas J Dermatol 1999; 40:141-3. [PMID: 10439525 DOI: 10.1046/j.1440-0960.1999.00345.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
An 80-year-old man with a 7 year history of a slowly enlarging, asymptomatic scrotal nodule is presented. He had a negative history for sexually transmitted disease, trauma to the area, radiotherapy and chemical or arsenic exposure. The lesion was excised with a margin of 0.8 cm of normal skin. Examination of the specimen revealed a basal cell carcinoma.
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Affiliation(s)
- J I Esquivias Gómez
- Department of Dermatology, University Hospital Río Hortega, Valladolid, Spain
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12
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Psoriasis. J Urol 1997. [DOI: 10.1097/00005392-199702000-00060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Affiliation(s)
- K R Loughlin
- Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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14
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Angulo JC, López JI, Flores N. Squamous cell carcinoma of the scrotum in an aluminium worker. Postgrad Med J 1993; 69:960-1. [PMID: 8121880 PMCID: PMC2400020 DOI: 10.1136/pgmj.69.818.960-a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Nahass GT, Blauvelt A, Leonardi CL, Penneys NS. Basal cell carcinoma of the scrotum. Report of three cases and review of the literature. J Am Acad Dermatol 1992; 26:574-8. [PMID: 1317891 DOI: 10.1016/0190-9622(92)70083-r] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Although basal cell carcinoma (BCC) is the most common human malignancy, only 21 cases involving the scrotum have been previously reported. OBJECTIVE Our purpose is to describe three additional cases of scrotal BCC and review the literature summarizing the clinical features and identifying any predisposing factors. METHODS We retrospectively reviewed 21 cases of scrotal BCC and described three new cases. Polymerase chain reaction (PCR) was used to detect human papillomavirus (HPV) DNA in our biopsy specimens. RESULTS Scrotal BCCs present as persistent ulcerations or plaques without identifiable predisposing factors. Lymphatic, pulmonary, or skin metastases were present in 3 of 24 cases (13%) resulting in death in one case. PCR did not detect HPV DNA in our three cases. CONCLUSION Scrotal BCC rarely occurs and should be considered in the diagnosis of a persistent scrotal ulcer or plaque. Metastatic disease may be more common than with other BCCs and wide local excision or Mohs micrographic surgery may be the most appropriate initial therapeutic approach.
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Affiliation(s)
- G T Nahass
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, FL 33101
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Schellhammer PF, Jordan GH, Robey EL, Spaulding JT. PREMALIGNANT LESIONS AND NONSQUAMOUS MALIGNANCY OF THE PENIS AND CARCINOMA OF THE SCROTUM. Urol Clin North Am 1992. [DOI: 10.1016/s0094-0143(21)00853-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Andrews PE, Farrow GM, Oesterling JE. Squamous cell carcinoma of the scrotum: long-term followup of 14 patients. J Urol 1991; 146:1299-304. [PMID: 1942281 DOI: 10.1016/s0022-5347(17)38073-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Squamous cell carcinoma of the scrotum was diagnosed in 14 patients from 1945 to 1990. Patient age at diagnosis ranged from 40 to 73 years, with the mean age of 62 years. The most common presentation was a solitary skin lesion but inguinal adenopathy was noted in 5 patients (36%). The mean delay to diagnosis for all patients was 22 months, with a range of 2 months to 10 years. Predisposing factors included psoriasis treated with coal tar or arsenic, human papillomavirus infection and multiple cutaneous epitheliomas. The primary lesion was treated by local or wide local excision in all 14 patients. In addition, 4 patients underwent inguinal lymphadenectomy and 3 underwent radiotherapy to the pelvic and inguinal lymph nodes. Mean followup for all patients was 6 years. However, 11 patients were disease-free with a mean followup of 7 years. Improved prognosis was noted in patients with locally confined disease or carcinoma in situ only. There was no correlation between grade of tumor and survival. All patients with stages A1 and B disease treated with wide local excision and/or inguinal lymphadenectomy have done well on followup. Radiotherapy does not appear to impact on survival for patients with high stage disease.
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Affiliation(s)
- P E Andrews
- Department of Urology, Mayo Clinic, Rochester, Minnesota 55905
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Affiliation(s)
- B T Parys
- Department of Urology, Royal Preston Hospital
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Abstract
Between January 1975 and December 1989, 13 men were treated for carcinoma of the scrotum; 11 lesions were squamous cell and 2 basal cell carcinomas. Eleven patients initially underwent local wide excision and 1 local excision with inguinal node dissection. Two patients died of recurrent disease and 4 from unrelated causes, giving a corrected 5-year survival rate of 62.5%.
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Affiliation(s)
- B T Parys
- Department of Urology, Royal Preston Hospital
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Abstract
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.
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Abstract
Squamous cell carcinoma of the scrotum is a rare malignancy in the United States. This series includes the eighth reported case of this lesion in a black American. Surgery still remains the only effective therapeutic modality. The use of sentinel and superficial inguinal node biopsies was important in determining whether or not radical ilioinguinal lymphadenectomy was needed in 2 patients.
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