Sequential use with imiquimod and surgery in extramammary Paget's disease

Abstract

Extramammary Paget's disease is an uncommon intraepithelial adenocarcinoma which occurs in areas rich in apocrine glands. Although surgery is the treatment of choice, numerous noninvasive treatments have been tried. There are studies that have demonstrated the efficacy of imiquimod to treat Extramammary Paget's disease, but we found no mention in the literature of its use as neoadjuvant therapy previous to surgery excision. We present a case of a large plaque of extramammary Paget's disease successfully treated with imiquimod and minor surgery of the residual disease.

Imiquimod in dermatology: an overview

“…Yet, therapeutic failure with disease progression has been reported in few cases . Some have also described imiquimod as neoadjuvant therapy before surgery, leading to tumor size reduction with subsequent easier surgical excision . Thus, the available evidence remains low quality based on which imiquimod should currently be considered as an alternative treatment for extramammary Paget disease, until larger studies confirm these effects.…”

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

“…Pretreatment of skin with ablative fractional lasers might enhance the uptake of topical MAL or ALA by the skin tissues . Topical imiquimod might be another option for the treatment of superficial EMPD, particularly in cases of extensive or multifocal tumors, or as neoadjuvant therapy prior to surgery of large lesion .…”

Extramammary Paget disease

“…Imiquimod 5% cream might also be beneficial as neo-adjuvant therapy by reducing the tumor size prior to surgical excision. By reducing lesion size prior to surgery, less cosmetic and functional damage would occur [43]. Further studies are needed to continue to look at the efficacy of this treatment option.…”

“…Topical photosensitizers, 5-aminolevilunic acid (5-ALA) and methyl-5-aminolevulinate (M-ALA), and an intravenous photosensitizer, porfimer sodium, have been employed in the treatment of EMPD. Housel et al reviewed the treatment of PDT to 24 lesions of non-invasive EMPD that had previously been treated with other modalities [43]. Sixteen lesions were treated with 5-ALA and nine with porfimer sodium.…”