The appropriate surgical treatment for suspected carcinoma of the testis is:

D. Inguinal exploration, control of the spermatic cord, biopsy, and radical orchectomy if tumor is confirmed.

 DISCUSSION: If, after physical examination, and even scrotal ultrasound, a tumor of the testicle is still suspected, the appropriate surgical treatment is high inguinal exploration with control of the cord, delivery of the testicle onto a protected field, biopsy if necessary, and then orchiectomy at the level of the internal ring if tumor is confirmed. Transscrotal manipulations, whether they be percutaneous or open, are to be condemned because of the possibility of tumor spillage with the ultimate necessity for hemiscrotectomy to control local recurrence. Certainly, repeated examinations over a very short period of time are appropriate, but no time should be lost if there is true suspicion of a testicular tumor. Before the high inguinal exploration it is helpful to obtain serum levels of the beta subunit of human chorionic gonadotropin and alphafetoprotein, which are important tumor markers. Surgical exploration should not be delayed until the actual laboratory values are determined, as they are important to the longitudinal course of the patient and not necessarily to the diagnosis.