Is it a second scrotum?

Dear Sir,

We would like to share a peculiar presentation of a superficial lipomatous naevus at the right inner thigh of a male patient, resembling the patient's nearby located scrotum.

A 35-year-old man presents with a slowly growing lesion on his right inner thigh. The lesion has been present for a few years. It makes the patient self-conscious but causes no other symptoms. The patient has no previous medical history and no family history of skin disease.

Clinical examination reveals a saccular lesion on the right inner thigh. It is a solitary, soft and skin-coloured lesion, resembling the patient’s nearby-located scrotum (Fig. 1). Ultrasound imaging shows a subcutaneous fatty content with no deep connections and no visible vasculature.

Resection under local anaesthesia is performed for cosmetic reasons (Fig. 2). Histopathological examination reveals a superficially subcutaneously located lipomatous lesion with mature, white adipose cells and polypoid transformation, compatible with naevus lipomatosus cutaneous superficialis (also called superficial lipomatous naevus or “fat naevus”). There is no dysplasia and immunohistochemical staining with Murine Double Minute 2 (MDM2) to rule out liposarcoma is negative.

A superficial lipomatous naevus is an idiopathic, cutaneous hamartoma that was first described by Hoffman and Zurhelle in 1921 [1]. It is defined by the presence of the aggregates of mature, ectopic adipocytes among the collagen bundles of the dermis. Typically, the lesions are either congenital or present by the third decade of life with no sex predilection.

A superficial lipomatous naevus is clini­cally classified into two types: classical or solitary. The classical form presents as multiple clusters of soft, skin-coloured nodules that mainly occur in the pelvic-girdle area. They have a zosteriform pattern and may either be sessile or pedunculated. The solitary form presents as a single, pedunculated, skin-coloured lesion that may occur anywhere on the body [2].

A superficial lipomatous naevus can be left untreated as it is a benign condition. In our case, resection under local anaesthesia was performed for cosmetic reasons. Its resection is usually curative.

Financial disclosures: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.

Gino Vissers, MD

Department of Plastic, Reconstructive and Aesthetic Surgery

 University Hospital Antwerp

 Drie Eikenstraat 655

B-2650 Edegem

 Belgium

e-mail: ginovissers@doctor.com