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Angiokeratoma of the Scrotum Treatment & Management

  • Author: Yoon-Soo (Cindy) Bae, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Apr 09, 2015
 

Medical Care

The importance of these lesions was well summarized by Bean, "These varicules should be known so that we can allay the fears of old men, many of whom have worries enough already." If the lesions are an incidental finding or are asymptomatic, the patient can be reassured about the lesions’ benign nature. If concern exists regarding bleeding or cosmetic appearance, then several surgical treatment options are available.

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Surgical Care

Excision

his is not practical if more than a few lesions exist. However, excision can be performed with the patient under local anesthesia, with a good cosmetic result.[2, 3, 4, 28, 33, 34] Obtaining negative margins has been recommended by authors who have treated recurrent angiokeratomas of the scrotum.[17]

Cryotherapy

Application of liquid nitrogen has been used with resolution of diffuse patterns, but with residual hypopigmentation and scarring.

Electrocautery

Light electrocoagulation has been used with or without local anesthesia to produce effective resolution of diffuse lesions.[2, 3, 4, 28, 33, 34]

Laser

Successful resolution has been reported with single treatments using both the 578-nm copper laser[33] and the argon laser,[34] resulting in minimal scarring.

A 2004 study showed benefit using a 532-nm potassium-titanyl-phosphate (KTP) laser.[28] Another study in 2006 evaluated the efficacy of pulsed-dye laser in 12 patients with scrotal angiokeratomas.[35] The results demonstrated good-to-excellent response in all patients, with transient purpura and minimal procedural bleeding as the only adverse effects.

In 2009, a study has shown long pulse 1-64 Nd:YAG laser to be effective, with at least 65-100% improvement in 10 patients and only 1 who had had a long-term adverse effect of an atrophic scar.[36]

A second study published in 2009 also using long-pulse 1064-nm Nd:YAG laser described 2 cases (one of the scrotum, one of the vulva) treated successfully with no recurrence in a 2-year and 6-month follow-up, respectively.[37]

In addition, ablative lasers such as carbon dioxide and erbium-doped yttrium aluminium garnet lasers have been used to remove the hyperkeratotic epidermis before treatment with a vascular laser.[38, 39]

Sclerotherapy

A 2010 article reported 3 cases treated successfully with repeated local injections of 0.5% ethanolamine oleate or 0.25% sodium tetradecyl sulfate. Both therapies had minimal and temporary adverse effects, including mild pain and epithelial sloughing with no scarring.[40]

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Consultations

Consult a dermatologist if the diagnosis is in doubt; alternatively, a biopsy can be performed on the lesions and can be submitted to a dermatopathology laboratory for microscopic diagnosis.

Consult a urologist if suspicion of a varicocele is present.

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Contributor Information and Disclosures
Author

Yoon-Soo (Cindy) Bae, MD Clinical Assistant Professor, Ronald O Perelman Department of Dermatology, New York University School of Medicine; Procedural Dermatologist, Laser and Skin Surgery Center of New York

Yoon-Soo (Cindy) Bae, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Medical Association, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, Massachusetts Medical Society, Women's Dermatologic Society, New England Dermatological Society

Disclosure: Nothing to disclose.

Coauthor(s)

Marianna Blyumin-Karasik, MD Dermatologist, Minars Dermatology; Consulting Dermatologist, Memorial Regional Hospital; Voluntary Instructor in Dermatology, Department of Dermatology and Cutaneous Surgery, University of Miami, Leonard M Miller School of Medicine

Marianna Blyumin-Karasik, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, Women's Dermatologic Society, Dermatology Foundation

Disclosure: Nothing to disclose.

Meredith M Hancock, MD Resident Physician, Department of Dermatology, Marshfield Clinic/Saint Joseph’s Hospital

Meredith M Hancock, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, Society for Pediatric Dermatology, Women's Dermatologic Society, National Psoriasis Foundation, Medical Dermatology Society

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Timothy McCalmont, MD Director, UCSF Dermatopathology Service, Professor of Clinical Pathology and Dermatology, Departments of Pathology and Dermatology, University of California at San Francisco; Editor-in-Chief, Journal of Cutaneous Pathology

Timothy McCalmont, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society of Dermatopathology, California Medical Association, College of American Pathologists, United States and Canadian Academy of Pathology

Disclosure: Received consulting fee from Apsara for independent contractor.

Acknowledgements

Vincent A De Leo, MD Clinical Professor of Dermatology, Department of Dermatology, College of Physicians and Surgeons of Columbia University; Chairman, Department of Dermatology, Director of Dermatology Residency Training Program, St Luke's-Roosevelt Hospital Center; Chairman, Department of Dermatology, Beth Israel Medical Center

Vincent A De Leo, MD is a member of the following medical societies: American Academy of Dermatology, American College of Occupational and Environmental Medicine, American Contact Dermatitis Society, American Dermatological Association, American Medical Association, American Society for Photobiology, Dermatology Foundation, New York Academy of Medicine, New York County Medical Society, Photomedicine Society, Society for Investigative Dermatology,Society of Toxicology, and Women's Dermatologic Society

Disclosure: estee lauder Consulting fee Consulting; laroche posay Consulting fee Consulting; schering plough Consulting fee Consulting; pfizer Consulting fee Consulting; orfagen Grant/research funds study – clinical

Amor Khachemoune, MD, CWS Mohs Micrographic Surgery, Dermatopathology, Department of Dermatology, State University of New York Downstate Medical Center; Consulting Staff, Department of Dermatology, Veterans Affairs Medical Center of Brooklyn

Amor Khachemoune, MD, CWS is a member of the following medical societies: American Academy of Dermatology, American Academy of Wound Management, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Medical Association, American Society for Dermatologic Surgery, and American Society for Laser Medicine and Surgery

Disclosure: Nothing to disclose.

Joseph J Shaffer, MBBS Fellow, Dermatologic Surgery, Department of Cutaneous Surgery, Fairview University Medical Center

Joseph J Shaffer is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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Image courtesy of Hon Pak, MD, and reviewed by Ross Levy, MD.
Close-up of the eruption. Image courtesy of Hon Pak, MD, and reviewed by Ross Levy, MD.
 
 
 
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