Ann Dermatol.  2013 May;25(2):213-217. 10.5021/ad.2013.25.2.213.

Extramammary Paget Disease: Minimal Surgical Therapy

• Choi JH
• Jue MS
• Kim EJ
• Joh OJ
• Song KY
• Park HJ

• KMID: 2171791
• DOI: http://doi.org/10.5021/ad.2013.25.2.213

Abstract

BACKGROUND
Extramammary Paget disease (EMPD) is an uncommon malignant neoplasm affecting apocrine gland-bearing skin which usually occurs in the anogenital area of patients older than 50 years. Although Mohs micrographic surgery (MMS) is recommended for the treatment of EMPD, wide local excision has also been performed by many other surgeons including dermatosurgeons. However, the extent of an adequate resection margin is still under debate.
OBJECTIVE
The efficacy of minimal surgical therapy consisting of a wide excision combined with preoperative multiple scouting biopsies and postoperative topical imiquimod was investigated for the treatment of EMPD in Korean patients.
METHODS
Between 2006 and 2012, 10 patients with primary EMPD were treated with wide surgical excision, with a surgical margin of less than 2.5 cm. Multiple preoperative scouting biopsies and postoperative topical imiquimod were also performed to delineate the lesional boundaries and to reduce the recurrence rate.
RESULTS
During the 6-year follow-up period, complications and recurrences were not observed.
CONCLUSION
Minimal surgical therapy may be an effective alternative when MMS is unavailable.

Keyword

Extramammary Paget disease; Imiquimod; Minimal surgical therapy; Scouting biopsy

MeSH Terms

Aminoquinolines
Biopsy
Follow-Up Studies
Humans
Mohs Surgery
Paget Disease, Extramammary
Recurrence
Skin
Aminoquinolines

Figure

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  Fig. 1 Preoperative photographs of the patients. (A) Penoscrotal (case 6), (B) vulvar (case 3).

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  Fig. 2 (A) Location of scouting biopsies marked 1 cm lateral to the clinically apparent margin. (B) Preoperative preparation. (C) Deep to the midsubcutaneous fat layer with a negative margin on a frozen pathological tissue section. (D) A 16/1000 inch split-thickness skin graft on the penile shaft and mesh grafts on the other sites.

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  Fig. 3 Postoperative photographs of lesional sites. (A) Case 6, (B) case 3.

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