PURPOSE: Penoscrotal extramammary Paget's disease is a rare cutaneous malignancy that primarily affects the elderly. To prevent local recurrence, adequate surgical excision with its intraoperative frozen section, proper reconstruction, and careful follow-ups are required. The present study describes the treatment of patients with penoscrotal extramammary Paget's disease, focusing on the reconstruction after the ablation of lesion. METHODS: Nine patients were selected who had undergone a local pedicle flap procedure due to the large defects after ablation of extramammary Paget's disease of the penoscrotal area, during the period of 1999 to 2005. Wide excision combined with intraoperative frozen sectioning was performed, and the penoscrotal wound was reconstructed with a local skin flap. Three flaps were chosen depending on the size of the defect. If the defect size was small and the scrotal tissue was adequate, scrotal flap(n=5) was enough for its reconstruction. However, as there were large defects with insufficient remnant scrotal tissue, a groin flap(n=2) or an anterolateral thigh flap(n=2) were performed. RESULTS: There were no complications with the postoperative wound. Furthermore, no local recurrence was noted during two to six years of follow-up period (mean average 3.7 years). CONCLUSION: For the resurfacing the penoscrotum at large defects after ablation of extramammary Paget's disease, we performed reconstruction with a local flap. In the aspect of both function and cosmetic concerns, the results were satisfactory.