Laser Ablation of Recurrent Paget's Disease of Vulva and Perineum

Valentine, B. H.; Arena, Bruno; Green, Elizabeth

doi:10.1089/gyn.1992.8.21

Cited by 15 publications

(3 citation statements)

References 5 publications

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“…Laser treatment of PDV gained interest in the hopes that it would provide a conservative approach to eradicate the disease while preserving vulvar anatomy and sexual function. This procedure has been used successfully [29, 30], but has the disadvantage of significant postoperative pain and high recurrence rate [19, 31]. Another option for clinical treatment of PDV, topical imiquimod 5% cream seems to be promising [25].…”

Section: Discussionmentioning

confidence: 99%

Paget’s Disease of the Vulva in Premenopausal Woman Treated with Only Surgery: A Case Report

Asmouki

Oumouloud

Aboulfalah

et al. 2012

Case Reports in Oncological Medicine

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Paget's disease of the vulva remains a rare condition with only a limited number of cases reported in the literature. It is an uncommon neoplasm usually of postmenopausal white women characterized by controversies in its prevalence, clinical features, treatment strategies, and prognostic. We here report a case of a primary Paget's disease of the vulva in premenopausal woman treated by only surgery with a favorable issue.

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Section: Discussionmentioning

confidence: 99%

Paget’s Disease of the Vulva in Premenopausal Woman Treated with Only Surgery: A Case Report

Asmouki

Oumouloud

Aboulfalah

et al. 2012

Case Reports in Oncological Medicine

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“…1 Nonsurgical modalities used alone or in conjunction with surgical excision may be more appropriate for some patients. In the past, such treatment modalities have included irradiation, [23][24][25] topical chemotherapy with fluorouracil 26,27 or bleomycin, 28 various systemic chemotherapeutic regimens, [29][30][31][32] laser ablation, [33][34][35][36] and photodynamic therapy, [37][38][39] with varying efficacy. Recently, topical imiquimod, 5%, has emerged as a potential treatment for superficial EMPD.…”

Section: Commentmentioning

confidence: 99%

Failure of Extensive Extramammary Paget Disease of the Inguinal Area to Clear With Imiquimod Cream, 5%

Green¹,

Burkemper²,

Fosko³

2011

Arch Dermatol

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Background: Surgical approaches are the standard treatment for extramammary Paget disease (EMPD), but nonsurgical modalities may be preferred and more appropriate for some patients. Topical administration of imiquimod cream, 5%, has improved or resolved in situ EMPD (n= 21), but treatment failures (n =6) have also been reported. Observations: We treated an elderly patient with initial biopsy-proved in situ genital EMPD with daily topical imiquimod, 5%, for 14 weeks. Midtreatment mapping biopsy specimens demonstrated invasive disease, with minimal clinical improvement. The patient subsequently underwent surgical excision. Conclusions: Of the 27 published cases that describe imiquimod treatment of EMPD, 6 report treatment failure (22%), but factors that may contribute to treatment failure are not well understood. In the present patient, treatment with imiquimod may have been complicated by variable lesion thickness, which inhibited uniform penetration of imiquimod, or the presence of invasive disease not detected on initial biopsy. The efficacy of imiquimod to treat extensive invasive EMPD has not been demonstrated, and surgical approaches remain the most appropriate treatment for invasive disease. Variable responses to topical imiquimod use among patients suggest that other factors may be important in determining response to therapy.

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“…Extensive vulvar surgery can cause permanent mutilation and functional impairment [ 18 - 22 ]. To address this problem, alternative treatment options such as photodynamic therapy, radiotherapy, chemotherapy, laser treatment, and recently topical 5% imiquimod cream have been used in patients with VPD with varying degrees of success [ 23 - 30 ].…”

Section: Introductionmentioning

confidence: 99%

The Paget Trial: A Multicenter, Observational Cohort Intervention Study for the Clinical Efficacy, Safety, and Immunological Response of Topical 5% Imiquimod Cream for Vulvar Paget Disease

Linden¹,

Meeuwis²,

Hees³

et al. 2017

JMIR Res Protoc

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BackgroundVulvar Paget disease is a rare skin disorder, which is most common in postmenopausal Caucasian women. They usually present with an erythematous plaque that may show fine or typical “cake icing” scaling or ulceration that may cause itching, pain, irritation, or a burning sensation. Although most cases are noninvasive, vulvar Paget disease may be invasive or associated with an underlying vulvar or distant adenocarcinoma. The histological evidence of so-called “Paget cells” with abundant pale cytoplasm in the epithelium confirms the diagnosis. The origin of these Paget cells is still unclear. Treatment of choice is wide local excision with negative margins. Obtaining clear surgical margins is challenging and may lead to extensive and mutilating surgery. Even then, recurrence rates are high, ranging from 15% to 70%, which emphasizes the need for new treatment options. A number of case reports, retrospective case series, and one observational study have shown promising results using the topical immune response modifier imiquimod.ObjectiveThis study aims to investigate the efficacy, safety, and immunological response in patients with noninvasive vulvar Paget disease using a standardized treatment schedule with 5% imiquimod cream.MethodsTopical 5% imiquimod cream might be an effective and safe treatment alternative for vulvar Paget disease. The Paget Trial is a multicenter observational cohort study including eight tertiary referral hospitals in the Netherlands. It is ethically approved by the Medical-Ethical Committee of Arnhem-Nijmegen and registered in the Central Committee on Research Involving Human Subjects (CCMO) Register by as NL51648.091.14. Twenty patients with (recurrent) noninvasive vulvar Paget disease will be treated with topical 5% imiquimod cream three times a week for 16 weeks. The primary efficacy outcome is the reduction in lesion size at 12 weeks after end of treatment. Secondary outcomes are safety, immunological response, and quality of life. Safety will be assessed by evaluation of adverse events and tolerability of treatment. To evaluate the immunological response, various immunological markers will be tested on biopsy specimens taken before, during, and after treatment. Quality of life will be assessed with three questionnaires taken before, during, and after treatment.ResultsFirst results are expected in the summer of 2018.Trial RegistrationClinicalTrials.gov NCT02385188; https://clinicaltrials.gov/ct2/show/NCT02385188 (Archived by WebCite at http://www.webcitation.org/6sXygHuhP).

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Laser Ablation of Recurrent Paget's Disease of Vulva and Perineum

Cited by 15 publications

References 5 publications

Paget’s Disease of the Vulva in Premenopausal Woman Treated with Only Surgery: A Case Report

Paget’s Disease of the Vulva in Premenopausal Woman Treated with Only Surgery: A Case Report

Failure of Extensive Extramammary Paget Disease of the Inguinal Area to Clear With Imiquimod Cream, 5%

The Paget Trial: A Multicenter, Observational Cohort Intervention Study for the Clinical Efficacy, Safety, and Immunological Response of Topical 5% Imiquimod Cream for Vulvar Paget Disease

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