Extramammary Paget Disease: Minimal Surgical Therapy

Choi, Ji Hyun; Jue, Mihn‐Sook; Kim, Eun Jung; Joh, Ok Ja; Song, Kye Yong; Park, Hyang Joon

doi:10.5021/ad.2013.25.2.213

Cited by 20 publications

(20 citation statements)

References 15 publications

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“…On the basis of these principles, the disease was improved as residual lesions after partial excision were affected with adequate thermal injury to the associated apocrine gland. As our method, minimal invasive surgery combining laser treatment, which results in minimal wound but leads to the best result, has been used widely for other dermatological diseases .…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of areolar Fox‐Fordyce disease with surgical excision and 1550‐nm fractionated erbium glass laser

Han

Lee

Rhie

2016

International Wound Journal

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Fox-Fordyce disease (FFD) is a rare chronic disorder characterised by persistent inflammation because of the obstruction of apocrine sweat glands, which is a key factor of pathogenesis. The treatment of FFD is known to be difficult, and the modalities of treatment have not yet been widely studied. We report the successful treatment of a case of bilateral areolar FFD by a combination of surgical excision and 1550-nm fractionated erbium glass laser in an 18-year-old woman. The patient presented with a bilateral areolar eruption of multiple, severely pruritic, 3-4 mm skin- to grey-coloured folliculocentric dome-shaped papules. The initial treatment plan was for bilateral surgical excision of the larger and more highly elevated papules via circumferential dermal excision, which was intended to maintain the areolar contour and minimise distortion. A 1550-nm fractional erbium glass laser was then used to control the remnant lesions. The patient was recurrence-free at 14 months after the final laser treatment, and she was fully satisfied with the treatment results.

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Section: Discussionmentioning

confidence: 99%

Successful treatment of areolar Fox‐Fordyce disease with surgical excision and 1550‐nm fractionated erbium glass laser

Han

Lee

Rhie

2016

International Wound Journal

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“…Wide local excision certainly is the general accepted standard to the surgical removal of Paget's disease. 2,21,[23][24][25] Nevertheless, the exact width of the margin to be taken has not reach consensus and has been reported as being from 1, 2.5, 3, up to 5 cm. 4,[25][26][27] The concern is the anticipated difficulty of wound closure with wide margin resections, thus it is necessary to define 'narrowest safe margins'.…”

Section: Discussionmentioning

confidence: 99%

“…Wide local excision certainly is the general accepted standard to the surgical removal of Paget's disease . Nevertheless, the exact width of the margin to be taken has not reach consensus and has been reported as being from 1 , 2. 5 , 3 , up to 5 cm.…”

Section: Discussionmentioning

confidence: 99%

Extramammary Paget's disease: Surgical control from the plastic surgery perspective

Wong

Cheung

2016

Surgical Practice

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Objective:Local recurrence is a common occurrence after surgical treatment for extramammary Paget's disease (EMPD). Current approaches have only focused on the narrowest safe margin necessary for local tumour removal. This leaves the multi-centric nature of the disease, which also accounts for recurrence, untackled. More extensive excisions, however, would entail reconstruction which in turn may mean additional morbidity. This study examined the relationship of reconstruction after resection with treatment outcome and post-operative recovery to look at the feasibility of wide local excision for achieving 'disease clearance'. Methodology:The records of patients who received surgical treatment for EMPD over a continuous 14-year period were reviewed. Primary outcome measures were margin clearance, local recurrence, complications and length of hospital stay. Results:Patients requiring reconstruction had better margin clearance and were not associated with more complications or prolonged hospital stay. They did not have more local recurrences despite having more advanced local disease. Conclusions:Modern reconstructive techniques can supplement wide excisions for EMPD so that there is no need to limit resection extent in order to reduce morbidity. More liberal excisions than recommended narrowest safe margins should be better able to eradicate disease.

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“…Surgery remains the treatment mainstay, but vulvar disfigurement and loss of sexual function must be considered. Laser therapy can preserve the anatomical structure, but the recurrence rate is high because of persistent residual HPV infection 4 , 5 . To ensure therapeutic efficacy, HPV elimination is considered important.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of 5% Imiquimod Cream on Vulvar Intraepithelial Neoplasia in Korea: Pilot Study

Kim

Lee

Kim³

et al. 2015

Ann Dermatol

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BackgroundVarious therapeutic options, including surgery, electrocautery, cryotherapy, 5-fluorouracil treatment, laser therapy, radiotherapy, photodynamic therapy, and interferon-α/γ injection, have been employed to treat vulvar intraepithelial neoplasia (VIN) with varying degrees of success. To truly cure VIN, human papillomavirus elimination is considered important.ObjectiveTo investigate the efficacy of 5% imiquimod cream used to treat VIN in Korean patientsMethodsWe performed a prospective, uncontrolled, observational study. Nine patients with histologically confirmed VIN applied 5% imiquimod cream to their vulvar lesions three to five times a week until a clinical response was apparent. All lesions were photo-documented, and therapeutic efficacy was assessed in terms of local adverse effects lesion number, size, and hyperpigmentation.ResultsThe mean treatment duration was 30.2 months, and the median follow-up period after therapy completion was 30 months. Of the nine patients recruited, six (66.6%) experienced complete responses (CR) or partial responses (PR). Hyperpigmented patches in the VIN lesions were evident in five subjects (55.6%), and all experienced either CR or PR. Only three patients (33.3%) suffered from local adverse effects, which were relieved after temporary suspension of therapy, and better outcomes were attained ultimately.ConclusionThe imiquimod cream was more efficacious when used to treat VIN of the hyperpigmented type compared with lesions lacking pigmentation. The unifocal nature of a lesion and the development of local adverse effects are useful factors when imiquimod cream is prescribed. However, although the cream is convenient and effective, regional resistance may develop, and close follow-up is essential because VIN may become malignant.

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Extramammary Paget Disease: Minimal Surgical Therapy

Cited by 20 publications

References 15 publications

Successful treatment of areolar Fox‐Fordyce disease with surgical excision and 1550‐nm fractionated erbium glass laser

Successful treatment of areolar Fox‐Fordyce disease with surgical excision and 1550‐nm fractionated erbium glass laser

Extramammary Paget's disease: Surgical control from the plastic surgery perspective

Efficacy of 5% Imiquimod Cream on Vulvar Intraepithelial Neoplasia in Korea: Pilot Study

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