Treatment of perianal Paget’s disease using photodynamic therapy with assistance of fluorescence examination: case report

Abstract

Our aim was to determine the usefulness of fluorescence examination and photodynamic therapy (PDT) for the management of perianal extramammary Paget's disease. A 75-year-old woman underwent two courses of PDT. The first treatment was carried out with topically applied 5-aminolevulinic acid (ALA) to the affected area (2.5 x 2.5 cm(2)) 3 h before light treatment. We used ALA/protoporphyrin IX (PpIX)-mediated fluorescence to visualize the lesion and its margins. The lesion was treated with a 630 nm laser at 120 J/cm(2). Forty days later, the residual lesion was given a second treatment at the same light dose after topical application of ALA and intravenous injection of HiPorfin. ALA/PpIX-mediated fluorescence served as a useful tool to visualize the lesion's location. Complete cure was achieved after the second course of PDT. During 7 months of follow up, no recurrence, scarring or functional loss was noticed. We concluded that ALA-assisted fluorescence examination can be a useful tool to determine the lesion and its margins. ALA-PDT is effective for superficial lesions, but, for thicker and deeper lesions, the systemic administration of photosensitizer is needed.

Extramammary Paget′s disease: Analysis of 17 Chinese cases

“…[23][24][25][26][27][28] In our opinion, surgical modalities should be considered to be the first choice for extramammary Paget's disease treatment until randomized studies with adequate follow-up have evaluated the non-surgical treatments.…”

Perianal Paget's disease: a diagnostic dilemma

“…Disadvantages with radiotherapy include radiation reaction which may be associated with proctitis, enteritis and cystitis. Li et al 11 have used PTD to treat one case of PPD. The lesion and its margins were visualised by application of a florescent agent, aminolevulinic acid/protoporphyrin IX (PpIX), prior to application of PTD.…”

Photodynamic therapy for anal cancer

“…Similarly, perianal Paget's disease was treated with success by Li et al [16]. In an interesting case report Li et al [17] employed ALA to first fluoresce and then treat an extensive perianal Paget's lesion, In this protocol, topical ALA was placed on the lesion for 3 h and fluorescence was then used to guide the illumination field size for therapy. A second course of ALA and Hiporfin PDT followed 40 days later with the patient achieving complete response.…”