Angiokeratoma of the Scrotum Treatment & Management

Updated: Aug 07, 2017
  • Author: Yoon-Soo (Cindy) Bae, MD; Chief Editor: Dirk M Elston, MD  more...
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Treatment

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, 25, 33, 34] Obtaining negative margins has been recommended by authors who have treated recurrent angiokeratomas of the scrotum. [18]

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, 25, 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. [25] 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]

More recently, 595-nm variable-pulse pulsed dye laser treatment has proven to be safe and efficient in removing angiokeratomas within 1-7 sessions. Of 24 treated patients, only 4 reported recurrence, with no serious adverse effects reported. [38]

In addition, ablative lasers such as carbon dioxide and erbium-doped yttrium aluminum garnet lasers have been used to remove the hyperkeratotic epidermis before treatment with a vascular laser. [39, 40]

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. [41]

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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 a varicocele is suspected.

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Long-Term Monitoring

If a surgical procedure is performed, follow-up care at 3 months post treatment is indicated to assess the cosmetic result and to look for recurrences.

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