Unusual Bleeding From Scrotal Skin - A Case Report with Review of Literature

Angiokeratomas include diverse conditions characterized by hyperkeratosis and superficial dermal vascular ectasia on histopathology. They are commonly asymptomatic and present with 1- to 6-mm, blue-to-red papules on a scaly background. They have been described on the scrotum, shaft of penis, vulva, inner thigh and lower abdomen. Angiokeratoma of scrotum (Fordyce’s spots) is a very rare entity. An association with increased venous pressure as in cases of varicocele has been noted in males. Morbidity in such a presentation is due to bleeding, anxiety and misdiagnosis leading to overtreatment. At times they can present as episodes of recurrent bleeding or as emergencies in the form of excessive bleeding. In general no treatment is required, however if required, local destructive procedures are employed like excision, electro coagulation, cryotherapy, or laser therapy. We describe here a case of 85 year old male who presented to us with complaints of numerous reddish spots over scrotal skin and painless bleeding from the same site. On local examination there were red maculopapular patches over the scrotal skin. No ulcer or growth was present. Rest of the perineal area and groin were normal. Systemic examination was normal except that patient was hypertensive. No immediate diagnosis was possible due to the rarity of presentation. Literature review helped us to make a presumptive diagnosis of angiokeratoma of scrotum. Patient undergone excision of involved skin with primary closure. The patient recovered well and is being followed up on out-patient basis with no recurrence or complication even after 1 year.