Treatment of Extramammary Paget's Disease with Topical Imiquimod

Min, Seong Uk; Cho, Young Joon; Moon, Sang Eun; Eun, Hee Chul; Cho, Soyun

Abstract

BACKGROUND: Extramammary Paget's disease (EMPD) is an intraepidermal adenocarcinoma which usually affects elderly individuals. Due to its multifocal nature and indistinct demarcation from normal skin, recurrences are common, even after invasive surgical treatment. Topical application of imiquimod, an immune response modifier, has been reported to be effective in the treatment of not only anogenital warts, but also cutaneous malignancies such as actinic keratoses and basal cell carcinoma. There are only a few case reports on the treatment of EMPD with topical imiquimod in the literature.
OBJECTIVE
The purpose of this study was to evaluate the effectiveness of topical imiquimod for the treatment of EMPD.
METHODS
Seven elderly patients (6 male and 1 female), whose ages ranged from 60 to 81 years (average, 68.4 years), were diagnosed with anogenital EMPD, which were further confirmed by skin biopsy. None of the patients were found to have associated internal neoplasms. Considering the patients' ages and morbidity associated with invasive treatment options, they were instructed to topically apply 5% imiquimod cream on their skin lesions once to three times a week. Imiquimod was applied for an average of 29.5 weeks. The patients were followed up on a monthly or bimonthly basis for any adverse affects or changes to the lesions. Residual lesions were surgically excised in 2 patients after 5 and 8 months of imiquimod application.
RESULTS
With long-term imiquimod application, all 7 subjects experienced transient irritation, erythema, focal erosion, or hypopigmentation of the application site. One patient experienced flu-like symptoms. Clinical cure was observed in all 7 patients during treatment, and/or early observation period. However, a pathologic cure was observed in 2 patients only. The lesions recurred in 3 patients during the follow-up period.
CONCLUSION
Since imiquimod has strong advantages in the preservation of function and cosmetics, it could be an effective primary treatment option for primary limited cutaneous EMPD, especially in elderly patients.