A Scrotal Rash Lasting Months in a Man With Genital Edema

Winston W. Tan, MD; Matthew S. Soberano, DO; A. Toledo, DO; Matthew Clarence Tan


June 23, 2022

Upon the diagnosis of prostate cancer with no metastasis, treatment options include prostatectomy, radiation, and interstitial seed implant or observation (watchful waiting). This patient had a radical prostatectomy. Postsurgery, PSA is often undetectable if the patient is cured of the disease. However, elevation of the PSA is the first sign of recurrence. In patients with no metastasis, patients are often either monitored or "started on antitestosterone treatment to suppress or make the cancer dormant."

The bone is the most common site of prostate cancer metastases; of those patients who have metastatic disease, 85% of patients develop bone metastases. Bone metastasis is commonly observed in the spine, pelvis, lumbar spine, and femur. Changes are osteoblastic, osteolytic, or mixed.[1,3] At times, metastasis from the vertebral body to the epidural space causes epidural compression of the spinal cord.[4] Other findings include anemia, bone marrow suppression, and fractures.

Additionally, the lymph nodes are also a common site for metastasis. Rare sites of metastasis include the skin, subcutaneous tissue, gastrointestinal tract, and brain.[5,6] Distant metastases to cutaneous and subcutaneous locations are present in 2%-9% of malignant tumors.[7,8]

The patient in this case was diagnosed with metastatic cancer on the skin of the scrotum. A punch biopsy of the skin revealed findings consistent with metastatic prostate cancer (Figure 2). PSA staining of the tissue was positive; this confirmed the prostate cancer as the origin of the metastasis (Figure 3).

Figure 2.

Figure 3.

The patient underwent mitral valve repair. During surgery, he was found to have metastasis to the lungs and the sternal bone. He recovered from surgery and slowly improved. He declined treatment except for leuprolide for the prostate cancer. His disease progressed, and he died within 6 months.


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