Interventions for the treatment of Paget's disease of the vulva

Edey, Katharine; Allan, Ernest; Murdoch, J.; Cooper, Susan M.; Bryant, Andrew

doi:10.1002/14651858.cd009245.pub2

Cited by 38 publications

(47 citation statements)

References 43 publications

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“…We were able to demonstrate not only safety and feasibility, but also a significant rate of complete clinical and histologic response in these patients. Recurrence rates were comparable to those reported in the published literature [9]. It is noteworthy that even the patients who eventually recurred after treatment with imiquimod preferred to use the topical cream again rather than undergo another surgical excision.…”

Section: Discussionsupporting

confidence: 81%

“…Historically, these procedures have ranged from the extensive and aggressive radical vulvectomy with skin grafting for reconstruction, to the more conservative (and common) wide local excision [9]. Regardless of approach, the data demonstrate high recurrence rates ranging from 30-60%, likely due to the presence of subclinical multifocal microscopic disease [1, 9, 14]. These recurrences may lead to secondary, tertiary, and even quaternary surgical procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Imiquimod appears to modify the biologic response to the tumor cells, enhancing immune function, and multiple case reports have shown that it confers a complete clinical response in vulvar EMPD [1, 6-8]. However, there are no prospective clinical trials evaluating EMPD and imiquimod therapy [9]. The objective of this prospective pilot study was to assess the clinical and histologic effects of topical imiquimod therapy on recurrent extramammary Paget's disease of the vulva.…”

Section: Introductionmentioning

confidence: 99%

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A pilot study of topical imiquimod therapy for the treatment of recurrent extramammary Paget's disease

Cowan

Black

Hoang

et al. 2016

Gynecologic Oncology

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Objective The objective of this prospective pilot study was to assess the clinical and histologic effects of topical imiquimod therapy on recurrent extramammary Paget's disease of the vulva. Methods Patients with biopsy-proven recurrent extramammary Paget's disease presenting to the gynecology outpatient services at two participating institutions were recruited for conservative treatment with 5% imiquimod cream from 2007 to 2011. The topical cream was to be applied 3 times per week for 12 weeks. Punch biopsy and photography were performed at baseline and at the 12-week time point. Results Eight patients from two institutions were enrolled. Complete clinical and histologic response was achieved in 6 (75%) patients by the 12-week follow-up appointment. Of the two remaining patients, one had a complete clinical response but no significant histologic response; the other patient was removed from the study protocol secondary to intolerable local irritation. Two patients continue to have no evidence of disease after a median follow-up of 35 months. Five are alive with disease. No patients progressed to invasive cancer while receiving therapy. Conclusion Topical 5% imiquimod cream is a safe and feasible option for women suffering from recurrent extramammary Paget's disease of the vulva, and should be considered as a viable alternative to surgical management. Given the rare nature of this disease, additional multi-institutional prospective studies should be conducted to explore the efficacy of this treatment regime.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A pilot study of topical imiquimod therapy for the treatment of recurrent extramammary Paget's disease

Cowan

Black

Hoang

et al. 2016

Gynecologic Oncology

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“…Although no RCTs with a sufficient sample size exist, the evidence is scarce and its recurrence is common, we suggest removal with free borders as treatment. Other treatments, such as laser, photodynamic therapy, radiation therapy and even the prior use of imiquimod to reduce the lesion, can be alternatives, although there is no strong evidence to support this [34].…”

Section: Intraepithelial Vulvar Neoplasia (Vin)mentioning

confidence: 99%

Spanish consensus on vulvar disorders in postmenopausal women

Comino¹,

Coronado²,

Cararach³

et al. 2015

Maturitas

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“…Because of rarity of this condition, no definitive treatment guidelines are available for diagnosis and management. Recent Cochrane review done on this disease noted that methods of diagnosis and treatment pattern differs significantly among physicians and surgeons; and definitive conclusion cannot be drawn based on available literature [1].…”

Section: Introductionmentioning

confidence: 99%

Extra Mammary Paget’s Disease of Vulva—a Case Report

Tomar

Suchetha

Nair

et al. 2016

Indian J Surg Oncol

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Extra mammary Paget's disease (EMPD) is a rare condition involving the vulva, anogenital region, and axilla. Vulvar disease usually presents as a slow growing well-defined itchy plaque with crustations or ulcerations over the affected area in postmenopausal women. Well-established guidelines for diagnosis and management are not available for this rare condition. Our patient is a 64-year-old postmenopausal woman with a history of similar complaints of 2 years duration, not responding to multiple topical treatments. She was diagnosed with EMPD on incisional biopsy and treated with surgery at our centre.

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Interventions for the treatment of Paget's disease of the vulva

Cited by 38 publications

References 43 publications

A pilot study of topical imiquimod therapy for the treatment of recurrent extramammary Paget's disease

A pilot study of topical imiquimod therapy for the treatment of recurrent extramammary Paget's disease

Spanish consensus on vulvar disorders in postmenopausal women

Extra Mammary Paget’s Disease of Vulva—a Case Report

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