Vulvar Paget disease: fluorescein-aided visualization of margins

Two women with extramammary Paget disease of the vulva were given fluorescein intravenously in order to visualize disease margins with the use of an ultraviolet light. As a diagnostic modality, the technique was found to have a positive predictive value of 97.4% and a negative predictive value of 99.9%. The accuracy of the fluorescein technique was compared with gross visualization using a histologic mapping technique. A total of 2424 fields were mapped and the predictive accuracy of each test was determined. A chi 2 test demonstrated fluorescein visualization to be a significantly better predictor of a disease state. Fluorescein visualization is suggested as an adjunct to surgical management of patients with primary vulvar Paget disease.