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Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.
user
The lymph nodes first involved in cancer of the skin of the scrotum are -
assistant
The correct answer is  • Squamous cell carcinoma of scrotumQ, most commonly resulted from exposure to environmental carcinogens including chimney soot, tars, paraffin and petroleum products.
• Superficial inguinal lymph nodes are the first lymph nodes involved. 
Risk Factors
• Most cases results from poor hygiene and chronic inflammation.
Diagnosis
• Diagnosis is established by biopsy of scrotal skin.
Treatment
• Wide excision with 2 cm margins should be performed for malignant tumors.
• Prognosis correlates with presence or absence of nodal involvement.