There are many causes of dark spots on the scrotum, such as hyperpigmentation, melanoma and pigmented basal cell carcinoma of the scrotum. 1. Hyperpigmentation: patients with dark spots on scrotum may have hyperpigmentation occurring in the scrotum area, which can be caused by long-term local friction. If the patient does not have any uncomfortable symptoms except black spots, no special treatment can be done and close observation is enough. 2. Melanoma: If the black spots in the scrotum are raised and have a tendency to increase in size in a short period of time, consider the possibility of melanoma, and patients with melanoma in the scrotal area may have the phenomenon of black spots in the scrotum. 3. Pigmented basal cell carcinoma of scrotum: basal cell carcinoma can be divided into nodular ulcerative type, pigmented type, scleroderma-like or fibrosis type and superficial type. Among them, pigmented basal cell carcinoma occurring in scrotum can have the phenomenon of dark spots in scrotum, but basal cell carcinoma is mostly seen in the elderly, and it occurs in the head, face, neck and back of hands. There are many other reasons that can lead to the appearance of black spots on scrotum, and it is recommended that such patients go to regular hospitals for diagnosis, clarification of the reasons and active treatment.