Scrotal Melanoma: A Systematic Review of Presentation, Treatment, and Outcomes

BACKGROUND: Primary male genital melanomas are rare. Of these, scrotal melanoma is the least common, and is unfortunately often detected late in the disease course. OBJECTIVE: To assess the clinical presentation, treatment modalities, and outcome of scrotal melanoma to aid clinician management. METHODS: Systematic literature review of PubMed, yielding 23 cases, of which 20 met the inclusion criteria. RESULTS: Although previously thought to have the best outcome of genitourinary melanomas, scrotal melanomas are associated with high mortality and late presentation. Scrotal melanoma presented as Stage I/II disease 18.75% of the time, Stage III 56.3% of the time, and Stage IV 25% of the time, whereas typical cutaneous melanoma presents as Stage I/II disease 84% of the time, Stage III 8% of the time, and Stage IV 4% of the time. Half of patients experienced recurrence of their disease. All patients who presented with metastases to distant organs died. LIMITATIONS: Small sample size. Few cases described a Breslow's depth making it difficult to draw conclusions on tumor thickness and survival outcome. CONCLUSION: Scrotal melanoma is rare, aggressive, and is often caught late in the disease course. The authors encourage dermatologists to educate patients and destigmatize genital lesions to increase the likelihood of earlier detection and better patient outcomes.

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