Data from six cases of penoscrotal Paget's disease were collected. Erythematous, indurated, and pruritic skin lesions that failed to respond to the topical therapy were the main complaints. Symptoms had been observed for three to seven years before correct diagnosis. Extensive diagnostic studies revealed negative findings of subjacent adenocarcinoma, but 1 patient had concurrent skin cancer of nasal ala. In treating penoscrotal Paget's disease, our policy is to (1) resect 3 cm or more skin beyond the margin of the cutaneous lesion, (2) resect deeply to the subcutaneous fat, (3) use intraoperative frozen sections to confirm the free margin and (4) reconstruct the wound with the local iliac flap. No local recurrence was noted during the follow-up period of two to seven years. The iliac flap is thin and pliable; it precluded scar contracture and painful penile erection, which are the common sequelae of free skin graft in the penoscrotal area. Patients enjoyed normal sexual activity after surgery.