Cavitational ultrasonic surgical aspiration (CUSA) 

Cavitational ultrasonic surgical aspiration (CUSA) is a medical technique that uses low-frequency ultrasound energy to break down and remove targeted tissue. Although rarely used for extramammary Paget’s disease (EMPD), it has occasionally been applied when a small area of diseased tissue needs to be removed. CUSA is typically considered only in situations where preserving surrounding tissue is a clinical priority.

The procedure is performed with a handheld device that fragments tissue using ultrasound energy and simultaneously removes it through an integrated suction system. This allows for controlled and localized tissue removal.

In some surgical settings, CUSA has been associated with reduced bleeding and improved visibility. It may also allow for more selective tissue removal compared to traditional instruments, depending on the characteristics of the lesion.

CUSA use depends on factors such as lesion size, depth, and location, clinical goals, and available surgical expertise. Patients should consult their healthcare provider to determine whether this approach is appropriate for their specific case.

Treatments for extramammary Paget’s disease (EMPD) often differ but frequently include one or more of the following: Mohs surgery, wide local excision (WLE) surgery, topical creams, carbon dioxide (CO2) laser, photodynamic therapy (PDT), cavitational ultrasonic surgical aspiration (CUSA), radiation therapy, skin grafts, and chemotherapy.