Breast Neoplasms ; Female ; Humans ; Paget Disease, Extramammary/surgery* ; Sweat Gland Neoplasms ; Vulvar Neoplasms/surgery*

BACKGROUND: Extramammary Paget's disease (EMPD) is an intraepithelial carcinoma usually occurring on the skin or mucosa of the perineum. Clinically, it resembles eczema or dermatitis, and misdiagnosis and treatment delays are common. The treatment of choice for EMPD is a wide excision with adequate margins. Wide excision with intraoperative frozen biopsy and Mohs micrographic surgery are common methods; however, these are associated with a high recurrence rate and long operation time, respectively. METHODS: Between January 2010 and June 2013, 21 patients diagnosed with EMPD underwent mapping biopsy. Biopsy specimens were collected from at least 10 areas, 2 cm from the tumor margin. When the specimens were positive for malignancy, additional mapping biopsy was performed around the biopsy site of the positive result, and continued until no cancer cells were found. Based on the results, excision margins and reconstruction plans were established preoperatively. RESULTS: The patients (18 male, 3 female) had a mean age of 66.5 years (range, 50-82 years). Almost all cases involved in the perineal area, except one case of axillary involvement. Permanent biopsy revealed one case (4.8%) of positive cancer cells on the resection margin, in which additional mapping biopsy and re-operation was performed. At the latest follow-up (mean, 27.4 months; range, 12-53 months), recurrence had not occurred. CONCLUSIONS: Preoperative mapping biopsy enables accurate resection margins and a preoperative reconstructing plan. Additionally, it reduces the operation time and risk of recurrence. Accordingly, it represents an effective alternative to Mohs micrographic surgery and wide excision with intraoperative frozen biopsy.
Biopsy* ; Carcinoma in Situ ; Dermatitis ; Diagnostic Errors ; Eczema ; Follow-Up Studies ; Frozen Sections ; Humans ; Male ; Mohs Surgery ; Mucous Membrane ; Paget Disease, Extramammary* ; Perineum ; Recurrence ; Skin

OBJECTIVETo investigate the clinical characteristics and surgical treatment of penile Paget's disease.

METHODSWe retrospectively analyzed the treatment and follow-up data of 10 cases of penile Paget's disease surgically treated in Jiangsu Provincial Government Hospital and Jiangsu Provincial People's Hospital from 2008 to 2012.

RESULTSAll the 10 patients received expanded local resection of the lesion with reconstruction of the defects with scrotal skin flaps or free skin flaps from the thigh. All surgeries were successful and the postoperative course was uneventful with complete graft survival and no lymph node metastasis. IIEF scores obtained before and 1 -2 months after surgery showed no statistically significant differences in the penile erectile function (P = 0.229), sexual orgasm (P = 0.761), and sexual satisfaction (P = 0.801) of the patients.

CONCLUSIONWhen penile skin lesions suggest the possibility of Paget's disease, biopsy should be performed and surgery should follow as soon as possible. The ideal surgical option is expanded local resection of the lesion with reconstruction of the defects with scrotal skin flaps or free flaps according to the patient's specific conditions.

Adult ; Aged ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Paget Disease, Extramammary ; surgery ; Penile Neoplasms ; surgery ; Retrospective Studies ; Treatment Outcome

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

Adult ; Aged ; Breast Neoplasms ; genetics ; metabolism ; pathology ; surgery ; Female ; Gene Amplification ; Genital Neoplasms, Male ; genetics ; metabolism ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Paget Disease, Extramammary ; genetics ; metabolism ; pathology ; surgery ; Paget's Disease, Mammary ; genetics ; metabolism ; pathology ; surgery ; Penile Neoplasms ; genetics ; metabolism ; pathology ; surgery ; Receptor, ErbB-2 ; genetics ; metabolism ; Scrotum ; Vulvar Neoplasms ; genetics ; metabolism ; pathology ; surgery

OBJECTIVETo explore the clinical manifestation, management, recurrence factors and prognosis of scrotal Paget's disease.

METHODSWe retrospectively analyzed the clinical and pathological data of 23 cases of scrotal Paget's disease diagnosed and treated in our hospital from 1996 to 2008.

RESULTSThe disease was confined to one side of the scrotum in 15, and involved the whole scrotum and penis in 8 of the cases. Three patients showed enlarged inguinal lymph nodes in the same side, and 2 in both sides. All the cases were confirmed by biopsy and treated by surgery. Post-operative follow-up was conducted for 2-68 months, which revealed 5 cases of local recurrence and 1 case of death for systemic metastasis.

CONCLUSIONBiopsy is proved to be important for the early diagnosis of scrotal Paget's disease, and extended excision of local lesion is a preferred management.

Aged ; Genital Neoplasms, Male ; diagnosis ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Paget Disease, Extramammary ; diagnosis ; pathology ; surgery ; Retrospective Studies ; Scrotum ; pathology

OBJECTIVETo investigate the causes, therapeutic methods and prognosis of recurrent extramammary Paget's disease of the penis and scrotum.

METHODSWe retrospectively studied the clinical presentations, therapeutic methods and prognosis of 18 cases of recurrent penile and scrotal Paget's disease, all diagnosed by biopsy and treated by surgical resection of the diseased sites. The incision reached the deep fascia. Frozen and olefin sections of the samples were pathologically examined to identify the involvement of the incisal edge. Seven cases had inguinal lymph node metastasis and underwent unilateral or bilateral inguinal lymph node resection.

RESULTSAll the patients were followed up for 6 months to 8 years (mean 34 months). Four died of distant metastasis and the other 14 experienced no recurrence.

CONCLUSIONFor the cases without metastasis of recurrent penile and scrotal Paget's disease, extended lesion-resection is a preferred option and the prognosis is good. And those with local lymph node metastasis need to undergo local lymph node resection.

Aged ; Aged, 80 and over ; Genital Neoplasms, Male ; surgery ; Humans ; Lymph Node Excision ; Male ; Middle Aged ; Paget Disease, Extramammary ; surgery ; Penile Neoplasms ; surgery ; Prognosis ; Scrotum

OBJECTIVESTo investigate the reconstruction of skin defect after extended resection of malignant skin tumor in or adjacent to the genitals, and to investigate the recovery of the function of urinary system and sexual intercourse after the operation.

METHODSFrom February 1998 to August 2006, 17 patients with carcinoma of sweat gland or Paget's disease in or adjacent to the genitals were given standard radical resections including groin lymph node dissections. The deformation of penis were corrected with the split-thickness skin grafts.

RESULTSA large split-thickness skin to cover the wound gave a good result. More than 95% of the skin survived, and the shape and function were perfect.

CONCLUSIONSIt is a simple and easy way to repair the skin defect. And the patients have a normal shape and function of genitals. The erectile function and the ability of sexual intercourse is good.

Adult ; Aged ; Aged, 80 and over ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Male ; Middle Aged ; Paget Disease, Extramammary ; surgery ; Penile Neoplasms ; surgery ; Reconstructive Surgical Procedures ; methods ; Scrotum ; Skin Neoplasms ; surgery ; Skin Transplantation ; methods ; Surgical Flaps ; Treatment Outcome

OBJECTIVETo explore the clinical features and plastic treatment of Paget's disease of the scrotum and penis.

METHODSWe analyzed 11 cases of Paget's disease of the scrotum and penis treated from 1997 to 2007. Extended excision of the focus of infection was performed and the skin absence was repaired by free skin grafting, local random skin flap, and island skin flap.

RESULTSSatisfactory wound healing was achieved in all but 1 case, which was delayed due to infection. All the patients were followed up for 1-4 years. One patient relapsed 2 years after the surgery and received a second operation, and another 1 died of lymphoma complicated by lung infection. The original shape and contractibility of the scrotum and penis were basically preserved and their appearance and function were fairly good.

CONCLUSIONFor patients with Pagets disease of the scrotum and penis, it is a desirable method to at once excise the lesion and repair the skin absence by plastic surgery.

Aged ; Aged, 80 and over ; Follow-Up Studies ; Genital Neoplasms, Male ; surgery ; Humans ; Male ; Middle Aged ; Paget Disease, Extramammary ; surgery ; Penile Neoplasms ; surgery ; Scrotum ; Skin Transplantation ; methods ; Surgery, Plastic ; methods ; Surgical Flaps ; Treatment Outcome

OBJECTIVETo investigate the clinicopathologic feature and treatment result as well as prognosis of Paget's disease of the scrotum.

METHODSThe data of 79 patients with Paget's disease of the scrotum confirmed pathologically from 1993 to 2004 were retrospectively analyzed. The median age of these patients was 62.3 years. The median duration of the disease was 3 years and 7 months. Locally extensive excision and intra-operative frozen section analysis of resection margin were performed in 78 patients. Inguinal and iliac radical lymphadenectomy was done in 7 patients with inguinal lymph node metastasis.

RESULTSLocal recurrence developed in 9 patients, and 3 patients died of the disease during follow-up.

CONCLUSIONThe prognosis of Paget's disease of the scrotum after surgical resection is good. To highly watch out for the disease, to perform histological examination and surgical resection as early as possible are keys to control it successfully.

Aged ; Aged, 80 and over ; Follow-Up Studies ; Genital Neoplasms, Male ; pathology ; surgery ; Humans ; Inguinal Canal ; Lymph Node Excision ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Paget Disease, Extramammary ; pathology ; surgery ; Prognosis ; Retrospective Studies ; Scrotum ; pathology ; surgery ; Survival Analysis