Scrotal Paget's disease: a case report and clinical analysis

This study reports the case of a 67-year-old man with scrotal Paget's disease. A systematic analysis of the clinical features, diagnostic and therapeutic strategies, and prognosis management of this rare disease was performed in conjunction with a literature review. The patient had a prolonged disease course with a history of three previous lesion excisions and presented this time due to lesion enlargement accompanied by mucous discharge. Dermoscopic examination revealed a "red background with punctate vessels," and preoperative epidermal histopathology supported the diagnosis of Paget's disease. The surgical approach involved wide excision of the lesion, aiming to remove the lesion as completely as possible while preserving the morphology and function of the surrounding tissues. Intraoperative frozen section analysis showed positive margins at the 1, 2, 6, and 11 o'clock positions. After further excision, immunohistochemical staining confirmed cytokeratin 7 (CK7) (+), gross cystic disease fluid protein-15 (GCDFP-15) (+), consistent with a sweat gland origin, and podoplanin (D2-40) (+), indicating a potential risk of lymphatic invasion. Finally, the patient was followed up regularly as planned, and at the most recent follow-up, no signs of recurrence were observed, and treatment outcomes were satisfactory, thereby allowing the discontinuation of further follow-up examinations. This case report provides a valuable practical reference for the standardized diagnosis and treatment of this rare condition.