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Intraoperative Immunostaining for Cytokeratin-7 During Mohs Micrographic Surgery Demonstrates Low Local Recurrence
Ali A Damavandy1, Vitaly Terushkin2, John A Zitelli3,4
1District Dermatology PLLC, McLean, Virginia.
Summary
Extramammary Paget's disease (EMPD) treatment using Mohs micrographic surgery (MMS) with intraoperative immunohistochemistry for cytokeratin-7 (CK-7) shows a low 3.3% recurrence rate. This combined approach (MMS + CK-7) significantly improves outcomes for EMPD patients compared to historical data.
Area of Science:
- Oncology
- Dermatology
- Surgical Pathology
Background:
- Extramammary Paget's disease (EMPD) is a rare intraepithelial malignancy.
- Standard surgical treatments for EMPD have high recurrence rates, ranging from 22% to 60%.
Purpose of the Study:
- To evaluate the local recurrence rate of Mohs micrographic surgery (MMS) supplemented with intraoperative immunohistochemistry for cytokeratin-7 (MMS + CK-7).
- To assess the efficacy of MMS + CK-7 for both primary and recurrent EMPD.
Main Methods:
- Retrospective, multi-center, cross-sectional study.
- Data collected via chart review including demographic, clinicopathologic, treatment, and follow-up information.
- Patients treated with MMS + CK-7 for EMPD.
Main Results:
- The local recurrence rate for EMPD treated with MMS + CK-7 was 3.3% (2/61 tumors) over a mean follow-up of 43.5 months.
- Recurrence rates were 2.3% for primary EMPD and 5.6% for recurrent EMPD.
- Kaplan-Meier 5-year tumor-free rates were 94.6% overall, significantly higher than historical controls (72.0%, p = .012).
Conclusions:
- Mohs micrographic surgery (MMS) supplemented with intraoperative immunohistochemistry for cytokeratin-7 (CK-7) is an effective treatment for Extramammary Paget's disease (EMPD).
- MMS + CK-7 demonstrates improved outcomes and lower recurrence rates compared to historical treatments for EMPD.