Squamous cell carcinoma of the groin is an extremely rare cancer and represents <2% of all squamous cell carcinoma primary sites. 
Risk factors include occupational exposure (tar, chimney sweeps), chronic mechanical irritation, and human papilloma virus. Here,  we present an unusual case of bilateral groin and perineal squamous cell carcinoma and the subsequent multidisciplinary management.

A retrospective chart review of notes, radiographic studies, and intraoperative photos was performed.

A 45 year old male presented to the emergency department with the complaint of large bilateral fungating groin masses with associated drainage and bleeding. Examination revealed huge bilateral groin, perineal and scrotal fungating masses. The left groin mass was ulcerating posteriorly (Figure 1). He noted that the masses had been increasing in size over the past 5 years. Excisional biopsy revealed well differentiated squamous cell carcinoma. Abdominal and pelvic imaging revealed no metastasis or lymphadenopathy. He was taken back to the operating room for bilateral wide local excision of the groins, perineum, and scrotum (Figure 2). To assist with wound healing post-operatively, Acellular dermal matrix, Kerecis, and vacuum-assisted wound closure were utilized. The wound had already healed very well at his first post-operative visit 2 weeks after discharge (Figure 3). Unfortunately, the tumor was invading the fascia over the left femoral vessels and a negative margin could not be achieved.  After case presentation at multidisciplinary tumor board, he underwent radiation therapy to the left groin tumor bed (6,000 cGy in 200 cGy per fraction).  Currently, the patient's wound has completely healed and he is doing very well on surveillance.

Scrotal and inguinal squamous cell carcinoma is an extremely rare cancer. At a large tertiary center in the United Kingdom, 10 cases were reported over a span of 10 years [1]. Human papilloma virus is a known risk factor for squamous cell carcinoma. The virus promotes carcinogenesis through oncoproteins E6 and E7, which target tumor suppressor genes p53 and Rb. Human papilloma virus appears to play a role in cutaneous squamous cell carcinoma, similarly to anogenital and oropharyngeal carcinomas [2]. Due to the rarity of this neoplasm, there is limited evidence regarding the role for neo-adjuvant and adjuvant treatment options [3].

Cutaneous groin squamous cell carcinoma is exceedingly rare and requires a multidisciplinary approach including urologic oncology, reconstructive urology, and radiation oncology.

Pang XY, Li Z, Zhang Y, et al. Primary squamous cell carcinoma of the scrotum: Outcomes from a specialist center. J Urol Oncol. 2023;45(3):234-241.
Aldabagh B, Angeles JG, Cardones AR, et al. Cutaneous squamous cell carcinoma and human papillomavirus: Is there an association? J Dermatol. 2023;50(4):123-130.
Khanna N, Arora A, Liebert CA, et al. Bilateral inguinal HPV-related squamous cell carcinomas with warty-basaloid features: An unusual presentation in a non-penile location. J Dermatol. 2023;50(6):789-795.