Extramammary Paget disease (EMPD) is a rare intraepithelial adenocarcinoma primarily affecting apocrine gland-rich areas, such as the scrotum. It often mimics benign dermatological conditions, leading to delayed diagnosis. This report presents a 72-year-old male with scrotal EMPD, emphasizing diagnostic challenges and surgical management.

Case A 72-year-old male presented with a progressively enlarging scrotal skin lesion for 1–2 years. The lesion measured approximately 4 cm with an irregular border. He denied pain, itching, or discharge. He visited dermatology OPD on January 18, 2025, where an incisional biopsy confirmed EMPD. Cancer markers were within normal limits. Whole-abdomen CT and colonoscopy were arranged to rule out associated malignancies. The patient was referred to the urology department for surgical management. After discussing treatment options, a wide excision with pedicled rotation SCIP flap reconstruction was planned. He was admitted for surgery on March 19, 2025. During surgery, an 11×5.5 cm skin defect was reconstructed using a SCIP flap, with the superficial circumflex iliac artery and vein as the pedicle. The recipient and donor sites were closed primarily, and a Penrose drain was inserted. Intraoperative near-infrared fluorescent angiography confirmed adequate flap perfusion. Postoperatively, the patient remained stable with well-perfused tissue and no signs of infection or wound complications. Pain was controlled, and antibiotics (Amoxicillin/Clavulanate) were administered.

EMPD is often misdiagnosed as eczema or dermatitis, leading to delayed intervention. Surgery remains the primary treatment, with wide excision required to prevent recurrence. Reconstruction using local flaps, such as the SCIP flap, is effective in preserving function and aesthetics.

Early biopsy is essential for diagnosing EMPD, especially in chronic, non-healing skin lesions. MRI or PET imaging can assist in preoperative staging, while immunohistochemical staining (CK7, P63) aids differentiation. A multidisciplinary approach, including dermatology, oncology, and urology, improves patient outcomes. Long-term follow-up is crucial due to the risk of recurrence or underlying malignancies.