BI48 Delayed genital cutaneous necrosis after hyperthermic intraperitoneal chemotherapy as an under-recognized complication: a two-case series

Abstract

Delayed-onset genital cutaneous necrosis is a rare complication of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS–HIPEC), most often associated with mitomycin C exposure (El Halabieh MA, Lodoli C, Ferracci F et al. Scrotal wall necrosis after HIPEC using mitomycin-C: case report and review of the literature. Int J Surg Case Rep 2025; 126: 110797). Fewer than two dozen cases are described in the literature, and the estimated incidence is around 1–1.5% (Baron E, Velez-Mejia C, Sittig M et al. Delayed genital necrosis after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with mitomycin-C. Eur J Surg Oncol 2021; 47: 2352–7). Presentation typically occurs weeks to months after treatment, with severe pain, eschar formation and progressive ulceration. With increasing use of CRS–HIPEC for advanced colorectal malignancy, awareness among dermatologists is important. We present a two-patient case series of men with sigmoid adenocarcinoma who developed painful scrotal eschars following CRS–HIPEC. In both cases, onset occurred 3 months after HIPEC and was characterized by severe pain and well-demarcated full-thickness scrotal eschar. Testicular ultrasound demonstrated scrotal wall thickening but no testicular involvement. Neither patient developed systemic instability. Multidisciplinary assessment supported HIPEC-associated cutaneous necrosis. Both were managed conservatively with antimicrobial therapy, advanced wound care including Flaminal enzymatic alginogel, and neuropathic analgesia. Clinical courses showed gradual demarcation, autodebridement, granulation and healing over a 2–3-month period, without surgical intervention. Published reports describe similar presentations, with proposed mechanisms including intraperitoneal chemotherapy tracking into the scrotum and local vesicant injury. Most reported patients underwent surgical debridement and primary closure. Recognition of this complication can prompt appropriate investigation, dermatology input and structured wound care. Our experience supports that selected clinically stable patients may be managed nonoperatively with regular follow-up and specialist wound care.