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Comparison of Mohs micrographic surgery and wide excision for extramammary Paget's Disease: Korean experience
Kyu-Yeop Lee1, Mi Ryung Roh, Woo Gil Chung
1Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seodaemoon-gu, Seoul, Korea.
Background:
Extramammary Paget's disease (EMPD) is an uncommon tumor that usually occurs on the genitalia. It almost always extends beyond clinically apparent margins and has a high rate of recurrence.
Objective:
To establish treatment guidelines for EMPD in Asian patients.
Methods:
A retrospective review was done on pertinent demographic data, tumor data, treatment characteristics, and follow-up data of 35 patients between 1996 and 2006. Review of literature for treatment modalities and recurrence rates of EMPD was also performed.
Results:
Thirty-four of the 35 patients (30 men and 5 women) had lesions in the genital area and one patient in the axilla. Mean follow-up duration was 62.7 months (8-156 months) and two of 11 (18.2%) recurred after Mohs micrographic surgery (MMS), compared with eight recurrences of 22 (36.4%) after standard wide excision. Two patients treated with nonsurgical modalities did not achieve complete remission. Estimated 5-year tumor-free rate using Kaplan-Meier graph was 69.7% in all patients, with a rate of 81.8% for MMS and 63.6% for wide excision.
Conclusions:
MMS is more effective, with lower recurrence rate than wide excision, and should be regarded as the first-line treatment for nonmetastatic EMPD.
Insights
Mohs micrographic surgery (MMS) offers a lower recurrence rate for extramammary Paget's disease (EMPD) compared to wide excision. MMS should be the primary treatment for nonmetastatic EMPD.
Area of Science:
- Dermatology
- Surgical Oncology
Background:
- Extramammary Paget's disease (EMPD) is a rare malignancy typically affecting the genital area.
- EMPD often presents with subclinical extension and has a high propensity for recurrence post-treatment.
Purpose of the Study:
- To develop treatment guidelines for extramammary Paget's disease (EMPD) specifically for Asian patients.
- To compare the efficacy of different treatment modalities for EMPD, focusing on recurrence rates.
Main Methods:
- Retrospective analysis of 35 EMPD patients' data (1996-2006) including demographics, tumor characteristics, treatments, and follow-up.
- Comprehensive literature review on EMPD treatment options and associated recurrence rates.
Main Results:
- Mohs micrographic surgery (MMS) demonstrated an 18.2% recurrence rate versus 36.4% for standard wide excision.
- The 5-year tumor-free rate was higher with MMS (81.8%) compared to wide excision (63.6%).
- Nonsurgical treatments failed to achieve complete remission in two evaluated patients.
Conclusions:
- Mohs micrographic surgery (MMS) is a more effective treatment for nonmetastatic EMPD than wide excision due to a significantly lower recurrence rate.
- MMS should be considered the preferred first-line surgical approach for nonmetastatic extramammary Paget's disease.
