RSS-Feed abonnieren
PDF herunterladen
DOI: 10.5999/aps.2014.41.6.753
The Effectiveness of Mapping Biopsy in Patients with Extramammary Paget's Disease
Gefördert durch: National Research Foundation of Korea R11-2005-065
Background Extramammary Paget's disease (EMPD) is an intraepithelial carcinoma usually occurring on the skin or mucosa of the perineum. Clinically, it resembles eczema or dermatitis, and misdiagnosis and treatment delays are common. The treatment of choice for EMPD is a wide excision with adequate margins. Wide excision with intraoperative frozen biopsy and Mohs micrographic surgery are common methods; however, these are associated with a high recurrence rate and long operation time, respectively.
Methods Between January 2010 and June 2013, 21 patients diagnosed with EMPD underwent mapping biopsy. Biopsy specimens were collected from at least 10 areas, 2 cm from the tumor margin. When the specimens were positive for malignancy, additional mapping biopsy was performed around the biopsy site of the positive result, and continued until no cancer cells were found. Based on the results, excision margins and reconstruction plans were established preoperatively.
Results The patients (18 male, 3 female) had a mean age of 66.5 years (range, 50-82 years). Almost all cases involved in the perineal area, except one case of axillary involvement. Permanent biopsy revealed one case (4.8%) of positive cancer cells on the resection margin, in which additional mapping biopsy and re-operation was performed. At the latest follow-up (mean, 27.4 months; range, 12-53 months), recurrence had not occurred.
Conclusions Preoperative mapping biopsy enables accurate resection margins and a preoperative reconstructing plan. Additionally, it reduces the operation time and risk of recurrence. Accordingly, it represents an effective alternative to Mohs micrographic surgery and wide excision with intraoperative frozen biopsy.
This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (R11-2005-065).
Publikationsverlauf
Eingereicht: 10. Juni 2014
Angenommen: 14. Juli 2014
Artikel online veröffentlicht:
05. Mai 2022
© 2014. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Chan JY, Li GK, Chung JH. et al. Extramammary Paget's disease: 20 years of experience in chinese population. Int J Surg Oncol 2012; 2012: 416418
- 2 Pitman GH, McCarthy JG, Perzin KH. et al. Extramammary Paget's disease. Plast Reconstr Surg 1982; 69: 238-244
- 3 Paget J. On disease of the mammary areola preceding cancer of the mammary gland. St Bartholomew Hosp Rep 1874; 10: 87-89
- 4 Mohs FE, Blanchard L. Microscopically controlled surgery for extramammary Paget's disease. Arch Dermatol 1979; 115: 706-708
- 5 O'Connor WJ, Lim KK, Zalla MJ. et al. Comparison of mohs micrographic surgery and wide excision for extramammary Paget's disease. Dermatol Surg 2003; 29: 723-727
- 6 Zhu Y, Ye DW, Chen ZW. et al. Frozen section-guided wide local excision in the treatment of penoscrotal extramammary Paget's disease. BJU Int 2007; 100: 1282-1287
- 7 Kodama S, Kaneko T, Saito M. et al. A clinicopathologic study of 30 patients with Paget's disease of the vulva. Gynecol Oncol 1995; 56: 63-70
- 8 Lloyd J, Flanagan AM. Mammary and extramammary Paget's disease. J Clin Pathol 2000; 53: 742-749
- 9 Koo YT, Minn KW, Chang H. Penoscrotal extramammary Paget's disease with multiple lymph node metastasis. Arch Plast Surg 2013; 40: 650-652
- 10 Chanda JJ. Extramammary Paget's disease: prognosis and relationship to internal malignancy. J Am Acad Dermatol 1985; 13: 1009-1014
- 11 Yoon ES, Choi JB, Han SK. et al. Treatment of extramammary paget's disease using the CO2 laser. J Korean Soc Plast Reconstr Surg 2000; 27: 169-172
- 12 Bewley AP, Bracka A, Staughton RC. et al. Extramammary Paget's disease of the scrotum: treatment with topical 5-fluorouracil and plastic surgery. Br J Dermatol 1994; 131: 445-446
- 13 Burrows NP, Jones DH, Hudson PM. et al. Treatment of extramammary Paget's disease by radiotherapy. Br J Dermatol 1995; 132: 970-972
- 14 Dengel L, Turza K, Noland MM. et al. Skin mapping with punch biopsies for defining margins in melanoma: when you don't know how far to go. Ann Surg Oncol 2008; 15: 3028-3035
- 15 Strauss RJ, Fazio VW. Bowen's disease of the anal and perianal area. A report and analysis of twelve cases. Am J Surg 1979; 137: 231-234
- 16 Kato T, Fujimoto N, Fujii N. et al. Mapping biopsy with punch biopsies to determine surgical margin in extramammary Paget's disease. J Dermatol 2013; 40: 968-972
- 17 Hatta N, Yamada M, Hirano T. et al. Extramammary Paget's disease: treatment, prognostic factors and outcome in 76 patients. Br J Dermatol 2008; 158: 313-318
- 18 Lai YL, Yang WG, Tsay PK. et al. Penoscrotal extramammary Paget's disease: a review of 33 cases in a 20-year experience. Plast Reconstr Surg 2003; 112: 1017-1023
- 19 Butler-Henderson K, Lee AH, Price RI. et al. Intraoperative assessment of margins in breast conserving therapy: a systematic review. Breast 2014; 23: 112-119
- 20 Lee KY, Roh MR, Chung WG. et al. Comparison of Mohs micrographic surgery and wide excision for extramammary Paget's disease: Korean experience. Dermatol Surg 2009; 35: 34-40
- 21 Goldsmith LA, Katz SI, Gilchrest BA. et al. Fitzpatrick's dermatology in general medicine. 8th ed. New York: McGraw-Hill Medical; 2012