Frozen Section-Guided Wide Local Excision in the Treatment of Recurrent Scrotal Extramammary Paget’s Disease

Abstract

Background: A wide excision is generally accepted to be the standard modality of treatment for scrotal extramammary Paget’s disease (EMPD). The disease has a recurrence rate of about 10% and a second wide excision is still the chief treatment. We investigated the therapeutic methods for recurrent scrotal EMPD. Methods: We retrospectively studied the therapeutic methods and prognosis of 26 cases of recurrent EMPD. Seventy-two cases of primary scrotal EMPD served as controls. All of the cases were treated with frozen section-guided wide local excision. Results: There was no significant difference in the follow-up period of the recurrent cases before recurrence (p = 0.3228), local recurrence rate (p = 0.449), and total recurrence rate (p = 0.100) between the two groups, respectively. There is a favorable trend of worse mortality rate in the recurrence group (p = 0.056). The rate of inguinal lymph node metastasis was higher in the group with recurrent disease than in the control group (p = 0.017). Conclusion: Wide excision of the lesion still appears to be the most effective modality of treatment for recurrent scrotal Paget’s disease. Inguinal lymphadenectomy or sentinel lymph node biopsy should be offered to patients with primary lesions.

A prospective pilot study to evaluate combined topical photodynamic therapy and surgery for extramammary paget's disease

“…Extended resection with 2–5 cm margin and the entire subcutaneous tissues might be required for certain cases. The recurrence rate after routine surgery is still high even for patients with negative boundary pathologic tests . Lai et al reported a local recurrence rate of 21.2% and distant metastasis rate of 9.1% in the penoscrotal region after surgery in their single hospital assay of 33 Chinese patients.…”

Extramammary Paget Disease of External Genitalia: Surgical Excision and Follow-up Experiences With 19 Patients

“…Among dermis-invasive cases, however, two patients with recurrence died of disease progression. In intraepidermal cases with local recurrence, wide excision of the lesion appears to be the most effective modality of treatment, as Li et al [16] had reported. However, dermis-invasive lesions with local recurrence should be managed by wide excision with adjuvant management such as radiation therapy.…”