Metastatic Adenocarcinoma of the Scrotal Skin from an Unknown Primary

A 67-year-old white man presented with a 3-year history of progressively worsening redness and irritation on the suprapubic area, scrotum, and penis. His primary care physician had been treating him unsuccessfully with topical antifungals and corticosteroids during this time. The patient had no significant pain, fever, chills, dysuria, gastrointestinal signs, or a history of sexually transmitted diseases. There was no previous history of malignancy, and his past medical history was not significant beyond an 8 pack-year history of tobacco use that was discontinued 40 years prior.