Mike, a 34-year-old builder, presents with a one-month history of dark red, dome-shaped papules on the scrotum.

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Mike, a 34-year-old builder, presents with a one-month history of dark red, dome-shaped papules on the scrotum.

These are not itchy or painful, but he has had a single episode of spontaneous bleeding from one of the lesions. There is no history of trauma.

Mike identifies as heterosexual and had a negative STI screen two months previously, as did his new partner at the time.

Mike’s father, also a builder, has had multiple non-melanoma skin cancers excised from the face and chest. There is no other significant medical history.

Examination is unremarkable apart from the scrotal lesions pictured (on next screen). Dermatoscopically, dark lacunae and a whitish veil are noted.