Modified peripheral and central Mohs micrographic surgery for improved margin control in extramammary Paget disease

Chang, Michael S.; Mulvaney, Patrick M.; Danesh, Melissa; Feltmate, Colleen M.; Schmults, Chrysalyne D.

doi:10.1016/j.jdcr.2020.11.002

Cited by 14 publications

(5 citation statements)

References 9 publications

(14 reference statements)

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“…In recent years, the Mohs micrographic surgery (MMS) technique has also been applied in the treatment of EMPD. [17,18] Compared with MMS, the operation duration is largely shortened by combining preoperative mapping biopsy and the local recurrence rate is equivalent. [19] Besides, alternative treatments such as topical imuquimod cream, photodynamic therapy, radiotherapy, chemotherapy and targeted therapy are available for EMPD.…”

Section: Discussionmentioning

confidence: 99%

Secondary perianal Paget’s disease from adenocarcinoma of the anorectal juncture:a case report

He¹,

Zhong²,

Peng³

et al. 2022

Preprint

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Background：Secondary extramammary Paget’s disease (EMPD) is a rare EMPD-like lesion deriving from the cutaneous extension of malignant cells and easy to be misdiagnosed. In this report, we present a more rare case suffered from secondary perianal Paget’s disease(PPD )which is associated with adenocarcinoma of the anorectal juncture. Case presentation：We experienced a rare case of secondary perianal Paget’s disease (PPD) which associated with adenocarcinoma of the anorectal juncture. Preoperative mapping biopsy was applied to the margin assessment. The patient recovered well with a comprehensive treatment. Conclusion：Perianal Paget disease secondary to adenocarcinoma of the anal canal is a rare disease. Early diagnosis and treatment for secondary PPD are critical for prognosis.Preoperative mapping biopsy could be considered as an alternative technique for margin assessment.

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Section: Discussionmentioning

confidence: 99%

Secondary perianal Paget’s disease from adenocarcinoma of the anorectal juncture:a case report

He¹,

Zhong²,

Peng³

et al. 2022

Preprint

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show abstract

“…However, because EMPD typically presents as a large skin lesion, MMS may be much more expensive and time consuming than WLE for such large lesions. To shorten time taken for the procedure of MMS, peripheral MMS, in which the periphery of the tumor is marked and excised until a clear margin is achieved, and its modified method have been developed [106,107].…”

Section: Evidence Of Treatmentmentioning

confidence: 99%

Extramammary Paget’s Disease: Diagnosis, Pathogenesis, and Treatment with Focus on Recent Developments

Ishizuki

Nakamura

2021

Current Oncology

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Extramammary Paget’s disease (EMPD) is a rare neoplasm that usually develops in apocrine gland-bearing areas, such as the vulva, scrotum, and penis. EMPD may present with a focal, multifocal, or an ectopic lesion. Clinically, EMPD lesions often exhibit infiltrative erythema, which is sometimes similar to other skin disorders such as eczema. While primary EMPD arises as intraepithelial neoplasm of the epidermis, EMPD-like lesions may occur from epidermotropic spread of malignant cells or direct extension from an underlying internal neoplasm, known as secondary EMPD. Because treatment strategies differ for primary EMPD and secondary EMPD, accurate diagnosis based on detailed histopathological evaluation is required. In the early stages, EMPD usually shows indolent growth, and most cases are diagnosed as carcinoma in situ. However, invasive lesions may result in metastases, and deep invasion is associated with high incidence of metastases. Conventional chemotherapies have been used for EMPD treatment in patients with distant metastases, but the efficacy is not satisfactory, and the prognosis for such patients remains poor. Recent studies have provided various insights into the molecular pathogenesis of the development and advancement of EMPD, which may lead to novel treatment approaches for metastatic EMPD. This review addresses the diagnosis, pathogenesis, and treatment of EMPD with focus on recent progress in understanding this disease.

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“…However, because EMPD typically presents as a large skin lesion, MMS may be much more expensive and time-consuming than WLE for such large lesions. To shorten the time taken for the MMS procedure, peripheral MMS, in which the periphery of the tumor is marked and excised until a clear margin is achieved, and its modified method have been developed [ 109 , 110 ]. Using this method, MMS in EMPD may become more common and useful in the future.…”

Section: Surgical Margin Of Primary Tumorsmentioning

confidence: 99%

Evidence from Clinical Studies Related to Dermatologic Surgeries for Skin Cancer

Ishizuki

Nakamura

2022

Cancers

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Despite the significant progress made in the past several years in pharmacotherapies for skin cancer, such as BRAF/MEK inhibitors, immune checkpoint inhibitors, and Hedgehog pathway inhibitors, surgical removal of primary skin cancer is still the first choice of treatment unless distant metastases are evident. In cases of lymph node metastases with clinically palpable lymphadenopathy, lymph node dissection (LND) is typically performed for most skin cancers. In the surgical treatment of primary skin tumors, the surgical margin is critical not only for reducing the possibility of tumor recurrence but also for minimizing the cosmetic and functional complications associated with wide local excision. In contrast, dermatologic surgery can cause various complications. Although skin graft is frequently used for reconstruction of the surgical defect, extensive graft necrosis may develop if optimal stabilization of the graft is not obtained. LND also sometimes causes complications such as intraoperative or postoperative bleeding and postoperative lymphoceles. Moreover, as in other types of surgery, surgical site infection, intraoperative anxiety, and intraoperative and postoperative pain may also develop. These complications are frequently associated with significant morbidity and discomfort. In this review, we summarize the evidence from previous clinical studies regarding the optimal surgical margin for skin cancer and the methods for diminishing the complications associated with dermatologic surgery.

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Modified peripheral and central Mohs micrographic surgery for improved margin control in extramammary Paget disease

Cited by 14 publications

References 9 publications

Secondary perianal Paget’s disease from adenocarcinoma of the anorectal juncture:a case report

Secondary perianal Paget’s disease from adenocarcinoma of the anorectal juncture:a case report

Extramammary Paget’s Disease: Diagnosis, Pathogenesis, and Treatment with Focus on Recent Developments

Evidence from Clinical Studies Related to Dermatologic Surgeries for Skin Cancer

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