Angiokeratoma of the Scrotum Treatment & Management

  • Author: Amor Khachemoune, MD, CWS; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Aug 16, 2011
 

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: This 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, 32, 33] 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, 32, 33]
  • Laser: Successful resolution has been reported with single treatments using both the 578-nm copper laser[32] and the argon laser,[33] 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.[34] 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.[35]
  • Laser: 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.[36]
  • 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.[37]
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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

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.

Coauthor(s)

Yoon-Soo Cindy Bae-Harboe, MD  Resident Physician, Department of Dermatology, Boston University School of Medicine, Boston Medical Center

Yoon-Soo Cindy Bae-Harboe, MD is a member of the following medical societies: American Medical Student Association/Foundation

Disclosure: Nothing to disclose.

Marianna Blyumin-Karasik, MD  Resident Physician, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine

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

Disclosure: Nothing to disclose.

Meredith M Hancock  Loyola University Chicago Stritch School of Medicine

Meredith M Hancock is a member of the following medical societies: American Medical Women's Association

Disclosure: Nothing to disclose.

Specialty Editor Board

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, and United States and Canadian Academy of Pathology

Disclosure: Apsara Consulting fee Independent contractor

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

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

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

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

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Joseph J. Shaffer, MBBS, and Vincent A. de Leo, MD, to the development and writing of this article.

References

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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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