Extramammary Paget’s disease (EMPD) and Skin Grafts
What is a Skin Graft?
A skin graft involves moving tissue from one location to another. A split-thickness skin graft (STSG) is sometimes used when large areas of extramammary Paget’s disease (EMPD) skin cancer are removed. A STSG has a low chance of rejection.
A STSG differs from a full-thickness skin graft (FTSG), which includes removing the epidermis and the entire thickness of the dermis. During a STSG procedure, a thin layer of skin encompassing the epidermis and a small part of the dermis is removed. The process is akin to to peeling a vegetable.
During surgery, doctors use a dermatome to carefully remove thin slices of skin from a donor area. Steve Schroeder – an EMPD patient – had tissue removed from his upper leg with the donor skin beginning used to replace cancerous EMPD areas. Having the STSG required Schroeder to be immobile for five days after surgery to insure that grafts had taken properly and healing was well underway. Full recovery time from skin grafts can be long for some people.
Both STSG's and FTSG's are often used in EMPD surgeries with split-thickness skin grafts being more common.
STSG’s vary in depth with thin grafts ranging from .005 inch to .012 inch, medium grafts ranging from .012 inch to .018 inch and the thick grafts ranging from .018 inch to .030 inch. FTSG's are thicker than .030 inch.
Often the most challenging part of a STSG is the pain associated with the donor site. Schroeder found the pain to be intense for the first few days but then tapered. As the STSG heals on the donor site, the bandages release starting with the edges. In the two different split-thickness skin grafts that Schroeder had, he found that the entire donor site bandage removed itself within two weeks.
In male EMPD patients, with large areas of EMPD on the scrotum, split-thickness skin grafts can be used to entirely rebuild a scrotum.
In addition to a STSG, skin flaps can also be used in extramammary Paget’s disease surgery. This can occur when excess tissue is available near the EMPD site. Surgeons can pull non-cancerous tissue to create a flap over an area where EMPD was removed.