Extramammary Paget’s disease (EMPD) is a rare intraepithelial malignancy arising in areas rich in apocrine glands, such as the perineum, vulva, axilla, scrotum, and penis. We describe the case of a man in his 50s who initially presented with a small eczematous lesion on his right groin, treated with topical ointments for eczema, until excisional biopsy of lesion unequivocally revealed invasive EMPD. Despite aggressive surgical interventions, his disease progressed to involve the scrotum and penis. Deemed unresectable, the patient was treated with systemic chemotherapy with minimal response. The rarity of EMPD, especially of the penis and scrotum, warrants an educated eye and heightened index of suspicion when dealing with eczematous lesions in the groin in any person. Early biopsy and histological examination is crucial for early surgical intervention of the lesions. There are no guidelines available to treat locally advanced unresectable disease. In addition, further studies are needed to identify genetic defects underlying the pathogenesis of this rare disease, to help improve treatment strategies and decrease morbidity.

ResumenLas mordeduras producidas por la araña reclusa café pueden causar una ulcera necrótica de crecimiento progresivo, tradicionalmente tratada en forma expectante, con antinflamatorios y con cirugía reconstructiva tardía.En este trabajo presentamos 2 casos clínicos tratados de forma exitosa por medio del dispositivo para el cierre asistido por presión negativa (VAC ®). Creemos que este dispositivo es un elemento importante para el manejo de esta patología, ya que la terapia por presión negativa ayuda a limitar la necrosis cutánea y a disminuir el tamaño de la ulcera y por lo tanto, acelera el proceso de recuperación del paciente.Palabras clave Picaduras araña, Heridas, Loxocelismo, Terapia de presión negativaCódigo numérico 15-15115-1526 AbstractThe brown recluse spider bite can cause an enlarging necrotic skin wound, traditionally treated with expectant management, anti-inflammatory drugs and late reconstructive surgery.In this paper we report 2 cases where we used Vacuum-Assisted Closure therapy (VAC®) for the successful management of these wounds. We believe that VAC® therapy is very effective in reducing wound size and skin necrosis, and also in accelerating patient recovery time.