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Volume 15, Issue 4 (July 2013) 15, 508–512; 10.1038/aja.2013.27

Penoscrotal extramammary Paget's disease: surgical techniques and follow-up experiences with thirty patients

Qi Chen*, Yan-Bo Chen*, Zhong Wang, Zhi-Kang Cai, Yu-Bing Peng, Da-Chao Zheng, Li-Ming Ma, Hai-Jun Yao and Juan Zhou

Department of Urology and Andrology, Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200011, China

* These authors contributed equally to this work.

Correspondence: Dr Z Wang, (zhongwang2001@yahoo.com); Dr ZK Cai, (13311630565@189.cn)

Received 29 December 2012; Revised 8 February 2013; Accepted 6 March 2013; Advance online publication 20 May 2013


To report the surgical management, complications and prognosis of patients with penoscrotal extramammary Paget's disease (EMPD) at different clinical stages. Between 2003 and 2008, a total of 30 male patients with penoscrotal EMPD were enrolled and evaluated. All enrolled subjects received frozen biopsy-guided local wide resection and immediate reconstruction. Patients were followed every 3 months postoperatively. Among the 30 patients who accepted and underwent frozen biopsy-guided local wide resection treatment and reconstruction, two (6.7%) cases exhibited positive margins, verified by pathological examination, and underwent re-excision after surgery. The technique of primary closure or an adjacent flap was used in 10 (33.3%) cases, split-thickness skin grafts were used in 15 (50%), and an anterolateral thigh perforator flap was used in five cases (16.7%). The postoperative complications were acceptable. The mean follow-up time was 64.9±29.6 months. Of all 30 cases, 22 patients (73.3%) survived with no evidence of recurrence, four patients (13.3%) exhibited local recurrence, two patients (6.7%) exhibited both local recurrence and distant metastasis and the remaining two patients (6.7%) exhibited distant metastasis. Five patients died from metastasis or cachexia. Current surgical techniques, including primary closure, adjacent flaps, split-thickness skin flaps and anterolateral thigh perforator flaps are able to reconstruct all types of defects with acceptable complications. Some patients with negative margins went on to exhibit local recurrence, potentially due to adnexal carcinoma or internal malignancy.

Keywords: frozen biopsy; Paget’s disease; penoscrotal reconstruction; surgical excision

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Asian Journal of Andrology CN 31-1795/R ISSN 1008-682X  Copyright © 2023  Shanghai Materia Medica, Chinese Academy of Sciences.  All rights reserved.