Surgical Excision of Multiple Penile Syringomas With Scrotal Flap Reconstruction

Elbert E. Vaca, MD; Gerhard S. Mundinger, MD; Jonathan A. Zelken, MD; Gulsun Erdag, MD; Michele A. Manahan, MD


ePlasty. 2014;14 

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To our knowledge, this represents the 12th reported case of penile syringoma and the first described surgical excision and reconstruction of multiple penile syringomas. The differential diagnosis for penile syringoma is extensive and partly includes bowenoid papulosis, sebaceous hyperplasia, epidermoid cysts, lichen planus, hamartomas, sarcoidosis, angiofibromas, and genital warts.[8,9,17] Because of their location, patients are usually distressed due to concern of a sexually transmitted infection and/or the appearance of such to their partners.[15]

Treatment is necessary only for cosmetic reasons. Apart from surgical excision, several other treatment modalities exist including electrocoagulation, liquid nitrogen cryotherapy, dermabrasion, and CO2 lasers.[15] However, given the intradermal location of these eccrine neoplasms, complete removal by these methods is difficult and reoccurrence is common.[18]

Surgical excision allows for the complete removal of the lesion but is more invasive and results in scarring. In the majority of instances, which are usually isolated, surgical excision is unnecessary. If the patient desires excision of isolated syringomas, closure can be achieved with elliptical excision, local undermining, and linear closure.

In our patient, multiple lesions were present over a large area of the shaft, necessitating skin grafting or local tissue rearrangement for coverage. We found scrotal flaps to be a viable option for reconstruction. Pliable adjacent scrotal tissue allows for tension-free closure of large defects and is an excellent functional substitute for penile skin as the loose connective tissue within scrotal dartos fascia permits adaptive conformation to penile spongiform changes. In addition, scrotal tissue possesses a rich blood supply via paired posterior scrotal arteries (superficial vessels from the deep internal pudendal arteries) lying within the dartos fascia, resulting in a robust vascular flap. Although reconstruction of the penile shaft with scrotal flaps carries some notable drawbacks, including transfer of hair follicles, sebaceous glands, and skin with dissimilar pigmentation, we do not think this functional result would have been achievable with other reconstructive options.