Indications for Lymph Node Dissection in the Treatment of Extramammary Paget's Disease

Tsutsumida, Arata; Yamamoto, Yuhei; Minakawa, Hidehiko; Yoshida, Takehito; Kokubu, Ichiro; Sugihara, Tsuneki

doi:10.1046/j.1524-4725.2003.29001.x

Cited by 67 publications

(85 citation statements)

References 14 publications

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“…We also found that among all of the patients with inguinal lymph node metastasis, the primary lesions involved the dermis. Other series demonstrated that the depth of involvement predicts a high possibility of inguinal lymph node metastasis [21,22]. This indicates that lymph node metastasis might originate from the primary lesion, rather than the recurrent lesion.…”

Section: Discussionmentioning

confidence: 96%

Frozen Section-Guided Wide Local Excision in the Treatment of Recurrent Scrotal Extramammary Paget’s Disease

Li²,

Xiang³

et al. 2012

Dermatology

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Background: A wide excision is generally accepted to be the standard modality of treatment for scrotal extramammary Paget’s disease (EMPD). The disease has a recurrence rate of about 10% and a second wide excision is still the chief treatment. We investigated the therapeutic methods for recurrent scrotal EMPD. Methods: We retrospectively studied the therapeutic methods and prognosis of 26 cases of recurrent EMPD. Seventy-two cases of primary scrotal EMPD served as controls. All of the cases were treated with frozen section-guided wide local excision. Results: There was no significant difference in the follow-up period of the recurrent cases before recurrence (p = 0.3228), local recurrence rate (p = 0.449), and total recurrence rate (p = 0.100) between the two groups, respectively. There is a favorable trend of worse mortality rate in the recurrence group (p = 0.056). The rate of inguinal lymph node metastasis was higher in the group with recurrent disease than in the control group (p = 0.017). Conclusion: Wide excision of the lesion still appears to be the most effective modality of treatment for recurrent scrotal Paget’s disease. Inguinal lymphadenectomy or sentinel lymph node biopsy should be offered to patients with primary lesions.

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Section: Discussionmentioning

confidence: 96%

Frozen Section-Guided Wide Local Excision in the Treatment of Recurrent Scrotal Extramammary Paget’s Disease

Li²,

Xiang³

et al. 2012

Dermatology

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“…Ensuring the depth as well as the extent of resection was an important feature of the operation. First, deep invasion of EMPD into subcutaneous tissues is possible [ 4,8 ] , and vertically inadequate resection could also lead to local recurrence. We controlled the surgical margin (horizontally and vertically), and the prevalence of local recurrence was much lower than that reported previously.…”

Section: Discussionmentioning

confidence: 99%

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

Xiao

Zhang

et al. 2012

BJU International

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Study Type – Therapy (case series)Level of Evidence 4What's known on the subject? and What does the study add?Both the treatment and reconstruction after resection of penoscrotal extramammary Paget's disease (EMPD) are of concern among oncological urologists. Reconstruction of large skin defects after wide local resection of this disease remains challenging and skilled work.For the first time, by using scrotal skin flaps, we have introduced an effective and reliable procedure into the new area of reconstruction for penoscrotal EMPD in selected patients, with satisfactory functional and aesthetic results.OBJECTIVE To introduce an effective procedure for reconstruction of large skin defects after wide local resection of penoscrotal extramammary Paget's disease (EMPD) in selected patients using scrotal skin flaps without compromising oncological control. PATIENTS AND METHODS From January to June 2010 this procedure was carried out in five selected patients with penoscrotal EMPD who underwent wide local resection with subsequent reconstruction using scrotal skin flaps. Patient demographics, lesion characteristics, surgical margins and outcomes were evaluated. Skin defects covered 48–96 cm2 (median = 72 cm2). The median (range) duration of follow‐up was 24 (22–27) months. RESULTS Flaps survived with satisfactory functional and aesthetic results. All patients survived without local or systemic recurrence of tumour. CONCLUSIONS Wide local resection can provide cure in superficial penoscrotal EMPD. The described method using scrotal skin flaps seems to be a safe and effective procedure for the reconstruction of large defects.

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“…A computed tomographic scan of the abdomen and pelvis is recommended to detect any associated or metastatic abdominal or genitourinary cancers [3]. If lymph node metastases are detected clinically or histopathologically, complete ilioinguinal lymph node dissection is indicated [8]. Screening with chest X-ray, colonoscopy, cystoscopy, and serum prostate-specific antigen levels is also performed by some physicians.…”

Section: Answermentioning

confidence: 99%

Enlarging Bump on the Scrotum

Cervantes

Rosen

Cho

2018

Skin Appendage Disord

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Extramammary Paget disease is a rare, slow-growing intraepithelial neoplasm of the skin or its underlying appendages. It more commonly affects the apocrine glands of the axilla, vulva, perianal region, scrotum, and/or penis. It often presents as a well-demarcated, thickened, erythematous, or gray-white scaly plaque with indolent growth that may become ulcerated, crusted, papillomatous, or eczematous over time. Pruritus, pain, and burning sensations are common symptoms; however, they are not appreciated by all patients. Many patients are erroneously treated for eczema for months to years before a proper diagnosis is reached. Patients presenting with chronic genital or perineal dermatitis or skin lesions that have been unresponsive to topical therapy should be biopsied for definitive diagnosis.

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Indications for Lymph Node Dissection in the Treatment of Extramammary Paget's Disease

Abstract: In the treatment of extramammary Paget's disease, indications of lymph node dissection are an important issue as well as wide local excision. From this prospective study, we have developed an algorithm for indications of lymph node dissection.

Cited by 67 publications

References 14 publications

Frozen Section-Guided Wide Local Excision in the Treatment of Recurrent Scrotal Extramammary Paget’s Disease

Frozen Section-Guided Wide Local Excision in the Treatment of Recurrent Scrotal Extramammary Paget’s Disease

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

Enlarging Bump on the Scrotum

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