To illustrate the heterogeneous care delivered to patients with Extramammary Paget's Disease (EMPD), a rare and lethal malignancy with poorly described treatment methodologies, by characterizing the clinical and pathological characteristics of an international patient support group.
Institutional review board approval was obtained to develop and distribute a non-validated survey to patients from an international, online EMPD support group. The survey was developed to capture patient clinical and pathological details and was distributed between January 2017 and February 2017.
Forty-two patients completed the survey. At a mean age of 64 years, patients most commonly developed rash, pruritus, or erythema in the genital and perianal regions. Patients presented to their primary care physician, gynecologist, or dermatologist and were initially treated with topical agents for benign diagnoses. After failing conservative treatments, patients underwent biopsy by a dermatologist or gynecologist and were diagnosed with EMPD on average 21 months after the onset of symptoms. Wide local and Mohs excisions were the most frequently administered treatments with positive margins reported in 43% of patients. Fewer patients underwent non-invasive treatment with Imiquimod cream and radiation. In total, 29% of patients developed regional recurrence and distant disease. There was wide variation regarding medical specialties involved, diagnostic evaluation, treatment, and clinical follow up.
This study provides a novel view of the varied clinical and pathological details from patients treated across varying institutions and medical specialties. This study will hopefully educate providers of the overall disease process of EMPD and encourage the development of standardized treatment recommendations.