Treatment of Extramammary Paget Disease and the Role of Reflectance Confocal Microscopy: A Prospective Study
| Autor: | Cristian Navarrete-Dechent, Andrea P Moy, Travis J. Hollmann, Cecilia Lezcano, Erica H. Lee, Klaus J. Busam, Saud Aleissa, Melissa Pulitzer, Frank Cordova, Andres M. Erlendsson, Anthony M. Rossi, Miguel Cordova, Mario M. Leitao, Brian P. Hibler, Max Polansky |
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| Rok vydání: | 2021 |
| Předmět: |
Reflectance confocal microscopy
medicine.medical_specialty business.industry medicine.medical_treatment Histology Imiquimod Dermatology General Medicine Radiation therapy Lesion 030207 dermatology & venereal diseases 03 medical and health sciences 0302 clinical medicine 030220 oncology & carcinogenesis Paget Disease medicine Surgery Radiology medicine.symptom Prospective cohort study business Dermoepidermal junction medicine.drug |
| Zdroj: | Dermatologic Surgery. 47:473-479 |
| ISSN: | 1524-4725 1076-0512 |
| Popis: | BACKGROUND Extramammary Paget disease (EMPD) poses treatment challenges. Invasive and noninvasive treatment modalities exist with variable success reported. Reflectance confocal microscopy (RCM) is emerging as an adjuvant diagnostic tool. OBJECTIVE To evaluate the treatment of EMPD patients and the role of RCM. METHODS Prospective study. Demographic and tumor characteristics were recorded. Handheld-RCM was performed and correlated with histology. Treatment, clearance, pathology, and follow-up were all recorded. RESULTS Thirty-six EMPD lesions in 33 patients were included. Mean age was 71.7 years, and 23 were men. Mean number of surgical stages needed to clear margins was 1.9 (SD, 0.9; 1.0-3.0 stages), and mean margin needed to clear was 1.8 cm. Reflectance confocal microscopy correlated well with scouting punch biopsies (kappa, 0.93; p < .001). Disruption of the dermoepidermal junction was associated with invasive EMPD versus in situ (83.3% vs 25.9%) on histology (p = .01). LIMITATIONS Relatively small sample size. CONCLUSION Extramammary Paget disease is challenging, and lesion demarcation is of the utmost importance. Using a staged surgical excision approach, the mean margins needed were 1.8 cm, less than previously reported. Nonsurgical modalities, including radiation therapy, imiquimod, or photodynamic therapy can be considered if surgery is not pursued. Reflectance confocal microscopy is a valuable noninvasive imaging modality for the management of EMPD. |
| Databáze: | OpenAIRE |
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