Successful treatment of three cases of primary extramammary Paget’s disease of the vulva with Imiquimod – proposal of a therapeutic schedule

Sendagorta, Elena; Pinto, Pedro Herranz; Feito, Marta; Ramírez, Paloma; Floristán, Uxúa; Feltes, Rosa; Benito, D.M.; Casado, Mariano

doi:10.1111/j.1468-3083.2009.03451.x

Cited by 46 publications

(37 citation statements)

References 6 publications

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“…Several case reports have shown that topical imiquimod 5% cream could be of great value in the management of perineal EMPD. Efficacy has been reported on vulvar [4,5], perianal [4,6] and peno-scrotal forms of EMPD [2,[7][8][9]. Unfortunately, the different treatment protocols chosen in these publications prevent from defining a clear protocol.…”

Section: Discussionmentioning

confidence: 99%

“…However, recurrence rate remains high and surgery has often significant consequences for the functional anatomy with irreparable tissue damage. Efficacy of imiquimod 5% cream has been assessed in different locations of female and male genitalia EMPD [2,[4][5][6][7][8][9]. We report here a successful treatment with imiquimod for relapsing peno-scrotal EMPD after multiple relapse after surgery.…”

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confidence: 91%

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Successful treatment of recurrent extramammary Paget's disease of the penis and scrotum with imiquimod 5% cream

2011

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 91%

Successful treatment of recurrent extramammary Paget's disease of the penis and scrotum with imiquimod 5% cream

2011

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“…It elicits the combined activation of natural, local innate immunity and T H 1 immune responses and inhibits T H 2 cytokines that are overexpressed in skin cancer. Imiquimod might also enhance Langerhans cell migration, induce apoptosis, and inhibit tumorassociated angiogenesis [9].…”

Section: Discussionmentioning

confidence: 99%

Conservative Management of Extramammary Paget Disease With Imiquimod

Baiocchi

Begnami

Fukazawa

et al. 2012

Journal of Lower Genital Tract Disease

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h AbstractObjective. Extramammary Paget disease is a rare cutaneous neoplasm that most frequently affects the vulva. Surgery remains the preferred treatment, despite its association with high recurrence rates. Few reports have described conservative treatments for vulvar Paget disease. Our aim was to evaluate the efficacy of conservative treatment with imiquimod.Materials and Methods. We performed a retrospective analysis of 4 patients who were treated with topical imiquimod 5% cream.Results. One patient underwent vulvectomy after imiquimod therapy, and 3 patients experienced extensive recurrent disease that was unsuitable for surgical resection and were treated successfully with imiquimod.Conclusions. Imiquimod is an effective therapeutic agent for the conservative treatment of vulvar Paget disease. h E xtramammary Paget disease (EMPD) is a rare cutaneous neoplasm that frequently manifests as an intraepithelial adenocarcinoma in situ that originates from intraepidermal apocrine glands or pluripotent keratinocyte stem cells [1]. It develops most commonly in the vulva but constitutes only 1% to 2% of vulvar malignancies [2, 3]. An underlying malignancy has been reported in 20% to 30% of EMPD [4,5], and the prevalence of invasive Paget disease or vulvar adenocarcinoma is 4% to 17% [5, 6]. Surgery remains the preferred treatment, despite the high recurrence rates [5,6]. Conservative management of EMPD with photodynamic therapy (PDT) has been reported with response rates that range from 50% to 78% [7]. Nevertheless, few reports evaluated EMPD treatment with imiquimod, but with promising results. We report 4 cases of vulvar EMPD that was treated clinically with imiquimod. MATERIALS AND METHODSThis retrospective analysis included 4 patients with EMPD who were admitted to . All patients had vulvar Paget disease and were treated with topical imiquimod 5% cream. All pathology slides were reviewed. The institutional research board has approved the study. RESULTSThe mean age at first diagnosis was 62.2 years (range = 56Y80 y). Three women were white, and 1 was Asian. All patients presented with a red, pruritic lesion and were initially treated topically with an antifungal and/or steroid cream without success. One patient had

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“…33 Some reports of patients with vulvar EMPD treated with local 5% imiquimod cream can show clinical and histologic remission within weeks of treatment. [34][35][36] No long-term results have been published to determine the recurrence rate of this treatment modality. Nonetheless, the acceptable side effects and the possibility of cure without surgery make imiquimod treatment a promising alternative.…”

Section: Treatmentmentioning

confidence: 96%

Staged marginal contoured and central excision technique in the surgical management of perianal Paget's disease

Möller

Lugo-Baruqui

Milikowski

et al. 2014

The American Journal of Surgery

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Successful treatment of three cases of primary extramammary Paget’s disease of the vulva with Imiquimod – proposal of a therapeutic schedule

Abstract: Based on our results, we consider that Imiquimod cream is a safe and effective therapeutic option for the treatment of vulvar EMPD. These promising results warrant further studies to determine the real efficacy and safety of Imiquimod 5% cream for the treatment of this uncommon disease.

Cited by 46 publications

References 6 publications

Successful treatment of recurrent extramammary Paget's disease of the penis and scrotum with imiquimod 5% cream

Successful treatment of recurrent extramammary Paget's disease of the penis and scrotum with imiquimod 5% cream

Conservative Management of Extramammary Paget Disease With Imiquimod

Staged marginal contoured and central excision technique in the surgical management of perianal Paget's disease

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