Frozen section‐guided wide local excision in the treatment of penoscrotal extramammary Paget’s disease

Abstract

OBJECTIVE To analyse the clinicopathological characteristics of penoscrotal extramammary Paget’s disease (EMPD) and to discuss the outcomes after frozen section‐guided wide local excision. PATIENTS AND METHODS From 1990 to 2005, at our institution, 38 patients with penoscrotal EMPD received wide local excision with intraoperative frozen‐section analysis. Their medical records were reviewed for patient demographics, lesion characteristics, surgical margin status, and clinical outcome. RESULTS No patients had EMPD secondary to a non‐cutaneous malignancy; 23 patients had intraepithelial EMPD, 12 had invasive EMPD and three had EMPD with underlying adnexal adenocarcinoma. The median (range) largest diameter of the lesion was 6 (1–20) cm. Of 38 patients, 12 (32%) had positive frozen‐section results and had extended surgical excision until a negative margin was obtained. Additional margin examination of the gross specimen and final examination of the frozen sections showed that five patients had false‐negative results. There was a microscopic positive margin in 15 of 38 (40%) patients when a conventional 2 cm clinical tumour‐free border was maintained. Skin erythematous patches were significantly correlated with the spread of disease (P = 0.03). After a median (range) follow‐up of 33.5 (3–140) months, six of 38 (16%) patients had recurrent disease, of whom only two had recurrent skin lesions, while four had systemic progression. CONCLUSION Frozen section‐guided wide local excision gave an acceptable recurrence rate in the treatment of penoscrotal EMPD. Primary EMPD with dermal invasion should be actively monitored for possible aggressive behaviour.

Reconstruction with scrotal skin flaps after wide local resection of penoscrotal extramammary Paget's disease

“…A median surveillance period of 24 months is not very long, but we can cautiously state that wide local resection probably provides a cure in individuals with superfi cial penoscrotal EMPD according to our previous research [ 2 ] . Conversely, if deep invasion of tumours into subcutaneous tissues is suspected intraoperatively, this method should be reserved with caution not only for the sake of oncological control, but also because aggressive resection can damage the underlying blood supply for future grafts (especially for the distal skin of the penis).…”

“…Early studies by our research team indicated that frozen section-guided wide local resection produces an acceptable prevalence of recurrence (16%) when treating penoscrotal EMPD. In general, the prognosis for primary penoscrotal EMPD confi ned to the epidermis is excellent [ 2 ] .…”

“…Secondly, resection of suffi cient depth could guide the grouping of patients with different recurrence risks and enable appropriate evaluation of the prognosis. This is because deep invasion not only increased the risk of residual tumours, but was also an important risk factor for systemic recurrence [ 2 ] .…”

“…• Skin defects covered 48 -96 cm 2 (median = 72 cm 2 ). The median (range) duration of follow-up was 24 (22 -27) months.…”

Penoscrotal extramammary Paget's disease: surgical techniques and follow-up experiences with thirty patients

“…[4][5][6][7][8] However, local wide excision and immediate reconstruction is the preferred treatment of Chinese urologists. [9][10][11] Our experience with 130 patients evaluated at mid-term follow-up demonstrated that intraoperative frozen-section biopsy was a reliable means to detect invisible tumours and could significantly reduce recurrence. 3 When we used this technique to completely resect the lesions and preserve normal tissues, we encountered the challenge of reconstructing the different sizes and shapes of postoperative skin defects ( Figures 1b, 2b, 3b and 4b).…”