Rapid Staining with Carcinoembryonic Antigen Aids Limited Excision of Extramammary Paget's Disease Treated by Mohs Surgery

Abstract

Extensive extramammary Paget's (EMPD) disease of the perineum in a 68-year-old man was treated by Mohs surgery. To facilitate identification of involved tissue a rapid staining carcinoembryonic antigen was used. This technique proved a useful adjunct to conventional hemotoxylin-eosin (H&E) stains. It was especially useful in highlighting involvement in areas of marked dysplasia/artifact where discrimination is often difficult. It is recommended that such a technique offers considerable benefits over H&E staining when confronted by such tissue morphology.

Extramammary Paget's disease: Surgical treatment with Mohs micrographic surgery

“…Means of improving the visualization of Paget's cells include obtaining thinner, more complete sections; quality staining of section; and the use of markers such as cytokeratin 7 19 and carcinoembryonic antigen. 20 All the tumors treated in our series were excised without the use of any markers. As immunohistochemical procedures become more standardized and easier to perform, the widespread use of such markers as cytokeratin 7 may lower the recurrence rate after MMS even further.…”

Long-Term Outcome of Perianal Paget's Disease

“…Although not frequently reported for perianal Paget's disease, Mohs microsurgery technique has been combined with rapid staining for carcinoembryonic antigen as another method for controlling local disease. 24 Our current treatment preference is to plan a wide excision based in part on the results of preoperative mapping with 4-mm dermatologic punch biopsies. The liberal use of intraoperative frozen sections helps to procure negative margins.…”

Extramammary Paget’s disease of the scrotum

“…This theory would account for the reportedly high incidence of "skip areas" between the subjacent invasive adenocarcinoma and the epidermal lesions. 5,7 Other investigators suggest that Paget's cells either derive from or differentiate toward exocrine and apocrine gland cells. This pathogenesis could explain why EMPD usually occurs in areas of the body containing exocrine sweat gland, and suggested that isolated EMPD may represent intraepithelial metastasis of an underlying exocrine gland adenocarcinoma.…”

“…One theory postulates that Paget's disease is the result of metastasis of underlying malignant cells to the overlying epidermis. 6,7 Another theory suggests that Paget's disease is the result of multiple foci of malignant transformation of a population of cells with a common embryological origin. This theory would account for the reportedly high incidence of "skip areas" between the subjacent invasive adenocarcinoma and the epidermal lesions.…”