Reconstruction with scrotal skin flaps after wide local resection of penoscrotal extramammary Paget's disease

Abstract

Study Type – Therapy (case series)Level of Evidence 4What's known on the subject? and What does the study add?Both the treatment and reconstruction after resection of penoscrotal extramammary Paget's disease (EMPD) are of concern among oncological urologists. Reconstruction of large skin defects after wide local resection of this disease remains challenging and skilled work.For the first time, by using scrotal skin flaps, we have introduced an effective and reliable procedure into the new area of reconstruction for penoscrotal EMPD in selected patients, with satisfactory functional and aesthetic results.OBJECTIVE To introduce an effective procedure for reconstruction of large skin defects after wide local resection of penoscrotal extramammary Paget's disease (EMPD) in selected patients using scrotal skin flaps without compromising oncological control. PATIENTS AND METHODS From January to June 2010 this procedure was carried out in five selected patients with penoscrotal EMPD who underwent wide local resection with subsequent reconstruction using scrotal skin flaps. Patient demographics, lesion characteristics, surgical margins and outcomes were evaluated. Skin defects covered 48–96 cm2 (median = 72 cm2). The median (range) duration of follow‐up was 24 (22–27) months. RESULTS Flaps survived with satisfactory functional and aesthetic results. All patients survived without local or systemic recurrence of tumour. CONCLUSIONS Wide local resection can provide cure in superficial penoscrotal EMPD. The described method using scrotal skin flaps seems to be a safe and effective procedure for the reconstruction of large defects.

Postoperative radiation therapy for extramammary Paget's disease

“…Although there is worldwide consensus that the most standard and reliable curative treatment for EMPD is surgery, the incidence of positive surgical margins and local recurrence is high, reaching 36–71% and 15–61%, respectively, after wide surgical excision . In addition, tumours in the genital area can be technically very difficult to excise widely, despite recent progress in reconstructive surgery, and insufficient surgical margins occasionally occur . Recently, Mohs micrographic surgery, in which frozen sections from all surgical margins are evaluated during surgery, has been preferable as an optimal strategy for EMPD.…”

“…1,2,[9][10][11][12][13] In addition, tumours in the genital area can be technically very difficult to excise widely, despite recent progress in reconstructive surgery, and insufficient surgical margins occasionally occur. 14,15 Recently, Mohs micrographic surgery, in which frozen sections from all surgical margins are evaluated during surgery, has been preferable as an optimal strategy for EMPD. Although this novel technique has contributed to the improvement of local control, 8-28% of patients with EMPD still develop local recurrence.…”

Midline raphe scroti artery flap for penile shaft reconstruction

“…In contrast to penile skin, it is thicker and contains hair and sebaceous glands. Several techniques were described to use scrotal skin for penile reconstruction, e.g., a scrotal dartos flap [20] , advancement flaps [13,21] or a ventral slit scrotal flap [22] . The drawback of local advancement flaps is the limited reach with coverage of the penile base and parts of the penile shaft but not the entire length of the penis.…”

“…Another reconstructive possibility is the use of scrotal skin. Despite the similarity of scrotal and penile skin -both are devoid of a subcutaneous fat layer and highly elastic -the reach of scrotal skin flaps is limited to the base of the penile shaft without the possibility of covering the entire shaft length [13] . Hence, temporary burying of the penis in the scrotum with delayed release, or local flaps for defects at the penile base are currently practised as well [14,15] .…”

A case of penile basal cell carcinoma reconstructed by scrotal myofasciocutaneous flap

“…Penile cancer is an extremely rare malignancy, accounting for only 0.4–0.6% of all malignancies . Most of these cancers, approximately 95%, are squamous cell carcinomas . BCC has a low incidence of metastasis, between 0.003 and 0.1% as it characteristically spreads by slow and local invasion .…”