Abstract: Gu Ankang, Zhang Junling, Kong Xiangjun, Liu Yujie, Xiao Yin, Ji Hua′an Department of Pathology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin 300120, China （Gu AK, Xiao Y, Ji HA）; Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin 300120, China （Zhang JL, Kong XJ, Liu YJ） Corresponding author: Gu Ankang, Email: guankang163.com@163.com 【Abstract】 Objective To analyze and compare reflectance confocal microscopy （RCM） features between Paget′s disease and eczema on the scrotum. Methods RCM was performed to image scrotal lesions of 5 male patients with suspected Paget′s disease and 5 male patients with eczema. Then, the scrotal lesions were resected and subjected to histopathological examination, and a comparison was conducted between the confocal microscopic and pathological findings. Results RCM imaging for the 5 cases of Paget′s disease showed disorganized epidermal structure, absence of normal honeycomb structures, single or clustered pagetoid cells in the prickle cell layer. RCM imaging for the 5 cases of eczema showed intercellular edema in the prickle cell layer, reticular degeneration of blisters in all the cases, and pustule formation in some cases. Conclusion RCM features are obviously different between Paget′s disease of the scrotum and scrotal eczema, so RCM imaging can facilitate the early diagnosis of Paget′s disease.