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Whether sentinel lymph node biopsy status is a prognostic factor or effective in determining treatment strategies in extramammary Paget disease remains unclear. This study aimed to investigate the significance of sentinel lymph node biopsy in extramammary Paget disease. We retrospectively reviewed the clinical information of previously untreated patients with invasive extramammary Paget disease who underwent wide local excision of the primary tumor and sentinel lymph node biopsy at our hospital between April 2008 and March 2021. Clinical data including the baseline neutrophil-to-lymphocyte ratio and recurrence-free survival were analyzed. Sentinel lymph node metastases were

F, Kirtschig G et al. Doxycycline versus prednisolone as an initial treatment strategy for bullous pemphigoid: a pragmatic, non-inferiority, randomised controlled trial. Lancet 2017; 389:1630-8.

Extramammary Paget disease (EMPD) is a rare, cutaneous malignancy that may occur in the genital and perianal regions in persons aged >60 years. 1 The incidence rate of EMPD in the United States has increased from approximately 0.3 per 10 million population in 1973 to more than 10 times that rate in 2013. 2 Prognosis of EMPD without distant metastasis is favorable, with a 5-year survival rate of 84%. However, once distant metastases occur, this rate falls to 7%. 3 Several studies have shown that cytotoxic anticancer agents, such as docetaxel, showed some efficacy in advanced EMPD cases.However, curative treatment has not been established, particularly in patients with visceral metastasis. [4][5][6] The neutrophil-to-lymphocyte ratio (NLR) utilizes a ratio of neutrophils to lymphocytes counted in peripheral blood to reflect prognosis and disease activity in many cancer types, including skin cancer. [7][8][9][10] In EMPD, similar to other skin cancers, sentinel lymph node biopsy positivity has been reported to be higher in cases of high NLR values. 8 However, the usefulness of NLR in predicting disease progression or survival in patients with EMPD has not been assessed. We hypothesized that NLR could help predicting prognosis in patients with EMPD and other cancer types. Therefore, we

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