Surgical Anatomy of the Genital and Inguinal Regions for the Dermatologic Surgeon: Landmarks, Danger Zones, and Perioperative Considerations

BACKGROUND: Genital and inguinal cutaneous malignancies are uncommon but clinically significant because of complex anatomy and potential morbidity. Nevertheless, these sites remain underrepresented in dermatologic surgery literature and training. OBJECTIVE: To practically review the anatomy relevant to cutaneous oncologic surgery of the male and female genitalia and inguinal region, emphasizing landmarks, danger zones, safe planes, and reconstruction. METHODS: A review was conducted. Clinical series, cadaveric studies, and reviews most applicable to dermatologic surgery were prioritized. RESULTS: Surface landmarks such as the penile and scrotal raphes, clitoral hood and fourchette, and the inguinal ligament help orient dissection. Safe undermining planes include the subdartos tissue of the penis and scrotum and tissue superficial to Scarpa fascia in the groin. Critical danger zones include the dorsal penile and clitoral neurovascular bundles, the ventral urethra at the frenulum and urethral meatus, the Bartholin glands at the posterior vestibule, and the femoral neurovasculature within the femoral triangle. CONCLUSION: As Mohs micrographic surgery is increasingly applied to genital and inguinal tumors, dermatologic surgeons will play a growing role in their management. Safe outcomes depend on respecting fascial planes and danger zones, and the principles summarized here provide a practical framework for excision and reconstruction.