Advances in Sexual Medicine, 2012, 2, 1-2 Published Online January 2012 ( 1
Biker’s Nodule: A Perineal Nodular Induration of
the Cyclist
Alakeel Abdullah, Halabi-Tawil Maya, Besseige Henri, Crickx Béatrice, Descamps Vincent
Department of Dermatology, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
Received October 29, 2011; revised November 30, 2011; accepted December 11, 2011
A case of “biker’s nodule” in an 80 year-old cyclist is reported. The “biker’s nodule” is caused by repeated microtrauma
to the subcutaneous fatty tissue or collageneous tissue on the perineal region resulting in a perineal nodular induration .
Keywords: Perineal Nodular Induration; Biker’s Nodule; Hygroma
1. Introduction
An 80 year-old patient consulted at our clinic for a large
perineal mass that had been growing very slowly over
time. The patient had no particular medical history, and
there was no family history of a similar anomaly. Of note,
he had been cycling for years. Physical examination re-
vealed a soft, non-painful mass inferior to the scrotum
(Figures 1 and 2). It had the size of an orange, and was
covered by normal skin. There was no lymphadenopathy.
The first evoqued diagnosis was a perineal lipoma. A
scrotal ultrasonography was done and revealed a small
varicocele and a bilateral vaginal hydrocele. It showed no
abnormality regarding the two testicles, as well as no
lymphadeno pathies. The diagnosis of perineal nodular in-
Figure 1. Non-painful mass inferior to the scrotum with
normal skin.
duration of the cyclist or “biker’s nodule” was made after
concertation with the urologists. The patient rejected the
surgical excision.
2. Discussion
Perineal nodular induration of the cyclist, also called
“ischiatic hygroma”, “accessory testicles”, “third testicle”
Figure 2. Perineal nodular induration.
opyright © 2012 SciRes. ASM
or “biker’s nodule”, seem to be relatively well known by
European sports medicine specialists as well as profes-
sional or amateur cyclists since they are virtually restrict-
ed to cyclists [1]. Clinically, it usually presents as two
nodules, one on each side of the raphe, although it occa-
sionally presents as a single nodule, which is then called
3rd testicle and is located immediately below the scrotum,
close to the ischial tuberosity [2,3].
Differential diagnoses include common minor disor-
ders such as cysts and lipomas, which can be easily rec-
ognised by ultrasonography. Biker’s nodule should also
be differentiated from another, rarer but more serious
condition known as aggressive angiomyxoma, which is a
variety of myxoid tumor that infiltrate locally and is as-
sociated with a high risk of local recurrence after resec-
tion, but has no metastatic potential.
It is believed that repeated microtrauma to the subcu-
taneous fatty tissue or collageneous tissue, caused by
pressure or vibration exerted by the bicycle's saddle on
the perineal region, lead to collagenous degeneration, my-
xoid alteration and pseudocyst formation, resulting in
biker’s nodule [4].
The treatment of these nodules mainly consists of re-
ducing the causative factors, which may lead to regression,
but surgical excision is most often needed. Steroid or hya-
luronidase injections may be helpful in early le sions and
if the patient is a professional cyclist, since surgical exci-
sion is a very difficult option in that case.
3. Conclusion
Biker’s nodule is a rare and benign entity but it represents
a genuine handicap for professional cyclists and can con-
traindicate cycling.
[1] N. De Saint Aubain Somerhausen, B. Geurde and Y.
Couvreur, Perineal Nodular Induration: The Third Tes-
ticle of the Cyclist: An Under-Recognized Pseudotu-
mour, Histopathology, Vol. 42, No. 7, 2003, pp. 615-
616. doi:10.1046/j.1365-2559.2003.01592.x
[2] P. N. Vuong, C. T. Camuzard and M. F. Schoonaert,
“Perineal Nodular Indurations (Accesory Testicles) in
Cyclists, Fine Needle Aspiration Cytologic and Patho-
logic Findings in Two Cases,” Acta Cytologica, Vol. 32,
No. 1, 1988, pp. 86-90.
[3] R. González-Pérez, L. Carnero, N. Arbide and R. Soloeta,
“Perineal Nodular Induration in Cyclists,” Actas Dermo-
Sifiliograficas, Vol. 100, 2009, pp. 907-922.
[4] P. Kohler, S. Utermann, B. Kahle and W. Hartschuh,
“Biker’s Nodule—Perineal Nodular Induration of the Cy-
clist,” Hautarzt, Vol. 51, No. 10, 2000, pp. 763-765.
Copyright © 2012 SciRes. ASM