Today, I would like to educate you about a rare but highly malignant disease called Paget’s disease of the scrotum. Although it is called a disease, it is malignant because it occurs on the scrotal skin and looks like eczema or inflammation, so it is also known as eczema-like cancer of the scrotum or inflammatory cancer of the scrotum. This cancer is due to a cancerous transformation of the epithelium of the hair follicles, sweat glands and sebaceous glands of the scrotum (pictured below). It was first reported by a foreigner named Paget, who found 15 female patients with chronic eczema in the nipple and areola area that was untreated and within 2 years all of these patients developed cancer, a cancer of the breast that came to be known as Paget’s disease of the breast. Later another foreigner, Croker, discovered that eczema-like carcinomas similar to those of the breast occurred in the skin of the penis and scrotum and were called Paget’s disease of the scrotum. As with other cancers of the scrotum, the exact cause of scrotal Paget’s disease is not known medically, but is presumed to be related to recurrent irritation by chronic inflammation of the scrotal area, trauma and recurrent viral infections (e.g. human papillomavirus 16 infection). This disease occurs mainly in men over 40 years of age, and because it does not grow as a mass as other cancers and does not have characteristic symptoms, it is often misdiagnosed and missed as scrotal eczema in patients with inflammatory scrotum disease. The main manifestations of scrotal Paget’s disease, according to some current studies, are (1) itching and lesions of varying degrees on the skin of the scrotum and perineum. Oozing, crusting, flaking, and ulcers may occur as a result of scratching of the itchy skin. The symptoms can be alleviated after topical medication, and the symptoms are recurrent and often misdiagnosed as scrotal eczema, which remains untreated for a long time, with the lesions gradually expanding and the disease lasting several years to more than 10 years. (2) With the development and recurrence of the disease, skin lesions, such as erosions and oozing, gradually appear, and the scope gradually expands, and in severe cases, skin ulcers or cauliflower-like masses may form. (3) Manifestations of cancer metastasis may appear, such as inguinal lymph node metastasis, those with enlarged inguinal lymph nodes; or even metastasis to abdominal lymph nodes and other organs. Scrotal Paget disease is often misdiagnosed or missed because it is difficult to determine the diagnosis with the naked eye alone. A pathological examination of the lesion is required to confirm the diagnosis. The diagnosis is made by finding Paget cells under the microscope in the basal or lower spinous layer of the epidermis. Once the diagnosis is confirmed, the first treatment option is surgery. Because the lesion is malignant, complete removal of the lesion tissue is required. The excision includes the entire scrotal skin over 2 cm of normal skin surrounding the lesion, including the epidermis and dermis up to the layer of the testicular sphincter. In cases of deep tissue invasion, the testes and spermatic cords should be removed together. Lymph node removal should be done if lymph node metastasis is suspected before surgery. Because of the extensive excision, skin defects are often present and therefore skin implants are usually required after surgery.