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A 64-year-old man presented with a 3-month history of a 4r6 cm eczematoid erythematous skin lesion in the penoscrotal area (Fig. 1). The lesion involved about half of the proximal penile shaft and the left scrotum; the lesion was con®rmed as extramammary Paget's disease (EPD) by skin-punch biopsy. Other studies including serum PSA, IVU, abdominal ultrasonography, gastric and colonic endoscopic examination showed no other abnormality. Using Wood's¯uorescent visualization, the EPD was identi®ed and the lesion treated with a CO 2 laser (10±60 W), resurfacing with 300±500 mJ of pulse energy. The resulting charred surface was removed by lightly abrading the surface with moist saline-soaked gauze. This process was repeated layer-by-layer using the same parameters until all remaining abnormal¯uores-cent tissue had been removed. The skin was vaporized to a depth of < 2 mm and horizontally 1 cm beyond thē uorescent area. After 10±14 days the wound healing was almost completed; at 1 month after treatment the healing of the lesion showed good granulation and nō uorescence was detectable for 2 months (Fig. 2). However, after 6 months there was a diffuse¯uorescent area at the treated site which was con®rmed as EPD by punch biopsy. The lesion was then widely excised with normal tissue for 3 cm beyond the¯uorescent lesion; the lesion was then covered by a split-skin graft from the buttock area. Case 2A 75-year-old man presented with a 4r5 cm eczematoid lesion in the penoscrotal area, diagnosed as EPD using a skin-punch biopsy. Other examinations to detect internal malignancy revealed RCC in the left kidney and the patient underwent left radical nephrectomy. The pathology revealed a clear-cell tumour of stage of T2N0M0. His Paget's disease was treated using the CO 2 laser, as described for the ®rst patient; however, eventually the lesion was excised and the wound grafted in the same way, because he had the same clinical course. Case 3A 74-year-old man who had a 3r5 cm pruritic eczematoid lesion for 2 years was diagnosed with EPD using skin-punch biopsy. No other internal malignancy was found by the other examinations described; the lesion was treated with the CO 2 laser as described. The clinical course was again the same as in the ®rst two Fig. 1. The gross appearance of penoscrotal EPD at diagnosis.

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