Elsevier

Urology

Volume 74, Issue 2, August 2009, Pages 474.e1-474.e3
Urology

Case Report
Extramammary Paget's Disease of Scrotum Treated With Radiotherapy

https://doi.org/10.1016/j.urology.2008.04.018Get rights and content

Extramammary Paget's disease (EMPD) of the scrotum is extremely rare. Most cases are found on the vulva or anus. It is generally accepted that EMPD is associated with an underlying carcinoma in situ. The lesion is located deep in between the dermal to epidermal layer. EMPD must be differentiated from benign papulosquamous disease, squamous cell carcinoma and melanoma. It can be managed by local excision and reconstruction with a skin graft or skin flap. Radiation and topical chemotherapy have also been used as alternative treatment strategies and are effective for local control.

Section snippets

Case Report

A 63-year-old man presented with a 4-year history of erythematous lesions accompanied by an itching sensation on the left side of the scrotum and inguinal area. Physical examination revealed a 7 × 6-cm well-marginated erythematous patch lesion on the left side of the scrotum and inguinal area without palpable inguinal lymph nodes (Fig. 1). The laboratory examination findings were normal. Biopsy of the skin revealed the infiltration of epithelioid cells into the epidermis, often with clear

Comment

EMPD was initially reported in 1889 by Crocker.1 Although the male genitalia was the first extramammary site described, it represents a rare anatomic location, with <30 cases reported.2 The diagnosis of EMPD can be made by skin biopsy of the lesion. Because a greater incidence of internal malignancy has been noted in the urinary tract, urethrocystoscopy, transrectal ultrasonography, and prostate-specific antigen tests should also be performed.2 Complete surgical excision of the skin and

Conclusions

To reduce the recurrence of EMPD, it is important to treat such patients with complete excision and to confirm that the surgical margin is negative. Other treatment options include topical or systemic chemotherapy and radiotherapy, but these are less effective and result in a high recurrence rate in patients with invasive Paget's disease. However, if the lesion is too large to reconstruct with skin grafts or if the patient cannot tolerate the operation, alternative treatments, such as topical

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