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Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, TXDepartments of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX
A 66-year-old female with extramammary Paget disease of the mons, perineum, vulva,
vagina, and lower abdomen, status postradical vulvectomy, multiple excisional procedures,
laser treatments, and radical cystectomy for bladder carcinoma in situ, presented
to the dermatology clinic. Examination revealed diffuse red erosions of the vulva
extending into the introitus with overlying maceration and scattered pink plaques
with overlying crust and scale of the mons pubis and the abdomen (Figure, A). Treatment with a mixture of 1:1 fluorouracil 5% cream with calcipotriene 0.005%
cream to the right mons and the lower abdomen and imiquimod 5% cream to the left mons
and the lower abdomen was begun but was discontinued secondary to irritation. A palliative
course of radiation therapy (30Gy in 10 fx) followed by imiquimod resulted in skin
and quality-of-life improvement. Radiation therapy should be considered in extramammary
Paget disease when surgery is not possible. Examination 10 weeks after radiation therapy
revealed significant erosion resolution (Figure, B).
A, Before radiotherapy, examination revealed diffuse red erosions of the vulva extending
into the introitus with overlying maceration and scattered pink plaques with overlying
crust and scale of the mons pubis and abdomen. B, After radiotherapy, examination revealed significant resolution of erosions.
Pyle. ExtramammaryPaget disease responsive to radiotherapy. Am J Obstet Gynecol 2022.
