LAUSR

Corresponding Author Bong Seok Shin Department of Dermatology, Chosun University College of Medicine, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea Tel: +82-62-220-3130, Fax: +82-62-224-3130, E-mail: [email protected] https://orcid.org/0000-0001-9618-1763 Dear Editor: A 54-year-old male presented with multiple nodules on the scrotum which lasted for 2 years. The lesions were distributed together on the right side of the scrotum (Fig. 1A). A punch biopsy was conducted on the scrotal nodule. Histological findings showed only keratin materials. After a month, the surgery was performed under local anesthesia. Multiple scrotal nodules, including part of the dartos muscles, were removed at once (Fig. 1B). Then, the defect site was repaired using an advancement flap with dartos muscle. Histological findings of the removed lesions showed several epidermal cysts. Epidermal cysts are well encapsulated, and histologically characterized by a lining of stratified squamous cells. Cysts that occur in the scrotum could often be left unnoticed, because they have no symptoms. However, if an infection occurs especially in multiple cysts, the infection could spread to the surrounding cysts and rarely, the whole scrotal wall. This can lead to serious complications, including Fournier’s gangrene and septicemia. This is why it is important to treat multiple cysts of the scrotum through complete excision. Multiple nodules on the scrotum could have several different diagnoses, including idiopathic scrotal calcinosis (ISC), steatocystoma multiplex, or milia en plaque (MEP). However, the most common misdiagnosis of scrotal cysts is ISC. It is a rare benign condition, which is termed as such due to the abnormal deposition of calcium in the scrotal skin or subcutaneous tissue. In the case of ISC, histological findings are characterized by the deposition of calcium in the dermis without an epithelial lining. Some authors suggest that ISC is actually