Surgical management of perianal Paget's disease - Case reports

Perianal paget's disease is an uncommon malignant diagnosis for which surgical treatment is primarily opted for. This study presents two case reports of perianal paget's disease treated with surgery in a tertiary care oncologic center in India. Case 1: A 72 year old man presented with an itchy white patch in the perianal region, with a biopsy done in 2015 revealing extra-mammary paget's disease. The patient reported to us in November 2018, following which he was reevaluated and subsequently underwent wide local excision, diversion loop colostomy, and bilateral medial thigh perforator fasciocutaneous flaps reconstruction. Final histopathological examination confirmed diagnosis of Paget's disease. Case 2: A 69 year old man presented with recurrent perianal paget's disease after surgical excision and radiotherapy in 2016. The patient underwent wide local excision, diversion colostomy, bilateral sentinel lymph node biopsy, left ilioinguinal block dissection, and reconstruction with multiple medial thigh fasciocutaneous flaps in December 2019. Discussions: Perianal paget's disease is a rare cutaneous malignancy. Although studies regarding effective treatments are lacking, surgical excision is considered the best modality. Wide local excision with or without reconstruction remains the treatment proven to be successful, regardless of which long term follow up is crucial to identify recurrence. Larger case series are required to further comprehend the histopathology of the disease to prevent misdiagnoses and identify effective methods of treatment.