Objective:Local recurrence is a common occurrence after surgical treatment for extramammary Paget's disease (EMPD). Current approaches have only focused on the narrowest safe margin necessary for local tumour removal. This leaves the multi-centric nature of the disease, which also accounts for recurrence, untackled. More extensive excisions, however, would entail reconstruction which in turn may mean additional morbidity. This study examined the relationship of reconstruction after resection with treatment outcome and post-operative recovery to look at the feasibility of wide local excision for achieving 'disease clearance'. Methodology:The records of patients who received surgical treatment for EMPD over a continuous 14-year period were reviewed. Primary outcome measures were margin clearance, local recurrence, complications and length of hospital stay. Results:Patients requiring reconstruction had better margin clearance and were not associated with more complications or prolonged hospital stay. They did not have more local recurrences despite having more advanced local disease. Conclusions:Modern reconstructive techniques can supplement wide excisions for EMPD so that there is no need to limit resection extent in order to reduce morbidity. More liberal excisions than recommended narrowest safe margins should be better able to eradicate disease.

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