The treatment of anogenital extramammary Paget's disease as part of a multidisciplinary approach: The use of Mohs surgery moat method with CK7

Abstract

Although most cases of extramammary Paget's disease (EMPD) are localized to the intraepidermal, the extensive subclinical extension can lead to high rates of marginal recurrence with wide local excisions and topically destructive treatments. Recurrence rates of EMPD treated with Mohs micrographic surgery (MMS) without immunohistochemical staining are better but variable. Here, we describe our multidisciplinary approach for treating large EMPD tumors of the anogenital region involving critical anatomy using MMS for peripheral margin clearance (moat method) and intraoperative CK7 immunostaining. Our clinical pearls for the management of anogenital EMPD are based on 53 multidisciplinary cases treated at the author's institution between 2014 and 2020.

Utility of Intraoperative Cytokeratin-7 Immunostaining During Mohs Micrographic Surgery for Sebaceous Carcinoma

“…Our CK-7 protocol is the same as the previously reported CK-7 protocol used in cases of extramammary Paget disease (EMPD). 3 In our practice, we use CK-7 IHC stain using an automatic stainer (Leica Biosystems, Wetzlar, Germany) (Figure 1).…”

The Paget Trial: topical 5% imiquimod cream for noninvasive vulvar Paget disease

“…3,6 Margin-directed surgeries, such as Moh's surgery, have excellent negative margin rates and low recurrence rates. 7,8 However, the excision size may therefore be much larger.…”