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Perianal Paget's Disease: A Challenge of Surgical Margins in Uncommon Clinical Presentations

Sarah K Whitehouse1, Heng-Chin Chiam1

  • 1General Surgery, Cairns Hospital, Cairns, AUS.

Cureus
|April 22, 2025
PubMed

Insights

Perianal Paget's disease, a rare condition, was unexpectedly found during surgery for anal adenocarcinoma. Achieving clear surgical margins proved difficult due to the disease's ambiguous borders.

Area of Science:

  • Dermatology
  • Gastroenterology
  • Surgical Oncology

Background:

  • Perianal Paget's disease is a rare intraepithelial adenocarcinoma.
  • It often presents insidiously with scaly, erythematous plaques.
  • It has a high association with underlying malignancies and challenges in achieving clear resection margins.

Observation:

  • This case report details the unexpected discovery of perianal Paget's disease.
  • The diagnosis was made during the excision of invasive adenocarcinoma of the anus.
  • The ambiguous borders of the disease presented significant challenges.

Findings:

  • Despite wide resection, surgical margins remained involved.
  • Perianal Paget's disease can be an unexpected finding during anal cancer surgery.
  • Achieving complete tumor removal is complicated by the disease's ill-defined boundaries.

Implications:

  • This highlights the importance of vigilance for perianal Paget's disease, even when treating other anal malignancies.
  • It underscores the difficulties in surgical management and the need for potentially multimodal treatment approaches.
  • Further research into optimal management strategies for cases with involved margins is warranted.
Keywords:
anal adenocarcinomaextramammary paget's diseaseperianal diseaseperianal surgeryprimary extramammary paget's diseasesurgery in perianal paget's disease

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