Extramammary Paget's disease treated with topical and systemic photodynamic therapy

Surgical excision and radiotherapy for extramammary Paget's disease (EMPD) at specific sites such as the groin and genitalia is often inappropriate. An 80-year-old man with histologically proven EMPD of the left groin and scrotum was referred for PDT. The lesion and normal skin thickness were measured by a 20MHz, two-dimensional 'B' ultrasound scanner (US). δ-5-Aminolaevulinic acid (ALA), was applied followed 6h later by irradiation using a filtered xenon-arc lamp. Clinical improvement was apparent four weeks after first PDT session with a reduction in ulceration and lesion size and moderate thickness reduction on US. Superficial ulceration recurred 9 months after the fifth treatment. This recurrence was treated with intravenously administered porfimer sodium. This, followed by one topical PDT treatment resulted in significant clinical and US cure and the patient remains disease free at 1-year follow-up.