Extramammary Paget disease of the perianal region: the potential role of imiquimod in achieving disease control

Knight, S. R.; Proby, Charlotte M.; Ziyaie, Dorin; Carey, Frank; Koch, S. M. P.

doi:10.1093/jscr/rjw110

Cited by 6 publications

(7 citation statements)

References 7 publications

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“…An attempt to label immunohistochemical features of primary PAPD with positive CK7 and negative CK20 versus secondary PAPD with negative CK7 and positive CK20 is based on very few patients [18] and did not manifest in this study. All patients who were CK20 positive were also CK7 positive, and the one patient with CK7 positive with a CK20 5% cream have noted some success, with some reporting elimination of small lesions [20][21][22][23][24]. Two patients from this cohort were treated with imiquimod with local control, but with eventual recurrence.…”

Section: Discussionmentioning

confidence: 99%

Perianal Paget's—an aggressive disease

et al. 2023

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Aim Perianal Paget's disease (PAPD) is a rare disorder with a predisposition to anal and colorectal malignancies and an unclear prognosis. Our previous 25‐year series demonstrated a non‐aggressive nature. This study aims to describe our updated institutional experience. Methods This is a retrospective review of all patients diagnosed with primary PAPD from 1991 to 2021. A prospectively maintained institutional database was searched which included demographics, clinical and pathological manifestations, treatment methods, recurrence, oncological outcome and mortality. Results Thirty patients were diagnosed with PAPD. Fifteen were women (50%); the average age at diagnosis was 71 ± 10.7 years, and the average lesion size was 3.7 ± 2.6 cm. At diagnosis, 12 (40%) were harbouring invasive anal adenocarcinoma. Eight (27%) developed adenocarcinomas concurrent with PAPD recurrence at a mean interval of 9 ± 4.4 years (range 1.9–14.8). The Kaplan–Meier curve estimated overall survival of 93%, 86%, 82%, 65% and 56% at 1, 3, 5, 10 and 15 years, respectively. Median survival was 16 years. Six (20%) had disease‐related mortality. Initially, nine (30%) were treated with abdominoperineal resection (APR), 15 (50%) underwent local resection, three (10%) were treated with radiotherapy, two (7%) received only topical therapy and one (3%) chose observation. Fifteen (50%) experienced recurrence of PAPD, two after undergoing APR. Five (17%) had persistent disease until death. Only 10 (33%) did not experience PAPD recurrence, seven of whom underwent APR. The mean follow‐up time was 9.2 ± 6.2 years. Conclusions Perianal Paget's disease is an aggressive entity with high rates of synchronous anal adenocarcinoma at diagnosis and development of metachronous adenocarcinoma later in life.

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Section: Discussionmentioning

confidence: 99%

Perianal Paget's—an aggressive disease

et al. 2023

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“…35,36 As an immune stimulator, imiquimod induces ROS, cytokine, and chemokine production, which facilitates the recognition and apoptosis of cancerous epithelial cells by macrophages and inflammatory immune cells. 37–40 The findings of this report suggest that further research into the use of adjunctive PDT and imiquimod should be conducted as mainstream treatment for EMPD. Surgical interventions are associated with both high recurrence rates, functional and aesthetic impairments, and as perioperative morbidities.…”

Section: Discussionmentioning

confidence: 87%

Treatment Outcomes of Adjunct and Stand-alone Photodynamic Therapy in Patients With Extramammary Paget Disease: A Literature Review

2023

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“…Other options were indeed possible instead of the wide-skin resection, such as topical chemotherapy, or laser or radiotherapy, but these have shown varying results [ 15 , 16 ]. In our opinion, these therapeutic alternatives should be employed only for patients for whom surgery is not possible.…”

Section: Discussionmentioning

confidence: 99%

Perianal Paget Disease: Different Entities With the Same Name

Santos

Soares

Presa-Fernandes

et al. 2021

Cureus

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Extramammary Paget disease (EMPD) is a rare form of cancer that involves skin areas rich in apocrine glands. The common sites of occurrence include the vulva, perianal region, perineum, and axilla. Perianal Paget disease (PPD) is a subset of EMPD, which arises in the perianal skin. The disease commonly presents with a thickened plaque-like lesion with erythema or white scaly appearance. It is generally classified into two categories based on the origin of the tumor cells: (1) primary PPD if the tumor arises from intraepidermal cells and (2) secondary PPD if cancer originates from the underlying colorectal or urinary tract neoplasm. Due to its rarity, only a few sporadic case reports have been published in the literature, and treatment methods are yet to be standardized. In light of this, we report two PPD cases with different etiopathogenesis and staging: one involved only the perianal skin without regional or metastatic disease, and was not accompanied by visceral adenocarcinomas although there was a previous history of sigmoid adenocarcinoma; the other was probably secondary to an anal canal tumor spreading with disseminated disease involving the perianal and perineum area with bilateral inguinal, pelvic lymph node, and liver metastasis. The treatment plans and the outcomes of both cases were necessarily different from each other.

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Extramammary Paget disease of the perianal region: the potential role of imiquimod in achieving disease control

Cited by 6 publications

References 7 publications

Perianal Paget's—an aggressive disease

Perianal Paget's—an aggressive disease

Treatment Outcomes of Adjunct and Stand-alone Photodynamic Therapy in Patients With Extramammary Paget Disease: A Literature Review

Perianal Paget Disease: Different Entities With the Same Name

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