A 34-year-old Moroccan man with Fitzpatrick skin type IV presented to the sexually transmitted diseases centre with multiple painless nodules involving the scrotum. The first lesions had appeared when he was 15 years old and had increased progressively in number and size. The patient was concerned about cosmesis and discomfort; however, the condition had not interfered with sexual relations or fertility. His medical history was unremarkable. There was no history of trauma, ulcers or infections of the genital area, and the patient denied any other skin diseases. He worked as a manual labourer.
On clinical examination almost the entire scrotal wall was seen to be covered by multiple, firm, hard, subcutaneous nodules with sparing of the median raphe skin. The largest nodule was about 20 mm in size. Laboratory investigations showed serum calcium, phosphate, and parathyroid hormone levels to be within the normal range. Ultrasonography of the testicles did not reveal any abnormalities.