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Skin diseases of the elderly
Published in Robert A. Norman, Geriatric Dermatology, 2020
Bowen’s disease, an intraepithelial squamous cell carcinoma which usually appears on exposed areas and on the mucous membranes, is called erythroplasia of Queyrat. Bowen’s disease favors fair-complexioned men. Sunlight and arsenic ingestion are believed to be causative. About 30% have multiple lesions. In 5% of patients it evolves into invasive squamous carcinoma. Paget’s disease and extramammary Paget’s disease are other intraepithelial carcinomas. The breast lesion (Paget’s disease) is associated with underlying ductal carcinoma of the breast (Figure 22). Extramammary Paget’s disease most commonly affects the vulva and male genitalia, perianal area and the axillae. The lesion is a sharply marginated erythematous oozing plaque which may itch. Extramammary Paget’s disease represents in some cases an extension of an underlying adenocarcinoma.
Malignant and premalignant conditions affecting the genital area
Published in Shiv Shanker Pareek, The Pictorial Atlas of Common Genito-Urinary Medicine, 2018
Extramammary Paget’s disease is a rare adenocarcinoma of the skin which is identical to Paget’s disease of the breast, but occurring at a different site – including the vulva in females (it may also occur in males on the penis in extremely rare cases). The disease was first described in 1874 by Sir James Paget who detailed several cases of the condition on the female nipple, all of which had underlying breast cancer. In extramammary Paget’s disease there may or may not be underlying cancer. When the disease occurs in the vulval area, there may be underlying adenocarcinoma in local glands or organs such as Bartholin’s gland, the urethra or the rectum. The disease occurs most frequently in older women over the age of 60 years, and predominantly in Caucasians.
Benign vulval problems
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Lubna Haque, Margaret Cruickshank
Extramammary Paget’s disease of the vulva is a rare condition seen in post-menopausal women. The main symptom is pruritus. On examination, discrete lesions usually affect hairbearing skin and not the mucosa, and have a florid eczematous appearance with lichenification, erythema and excoriation. Extramammary Paget’s disease can be associated with an underlying adenocarcinoma. Imaging is recommended for the GI and urinary tracts and breasts but there is insufficient evidence to advocate best practice.
Efficacy of trastuzumab in HER-2-positive advanced extramammary Paget’s disease
Published in Expert Opinion on Biological Therapy, 2022
The authors highlight the potential of T-DXd in the management of HER-2 positive cancers [1]. We would like to highlight additional data that support the potential therapeutic role of T-DXd for the treatment of extramammary Paget’s disease (EMPD), another neoplasm with HER-2 expression that was not discussed by Perez et al. EMPD is an intraepithelial adenocarcinoma often involving apocrine gland-bearing locations such as the vulva and perianal area [2]. EMPD is usually associated with a favorable prognosis with surgery or topical agents, leading to an overall five-year survival of 75% to 95% [2], but invasive disease leading to progression and metastasis portends a poorer prognosis [2]. Systemic therapy is often warranted in the presence of metastasis but often with inconsistent results [2]. In addition to surgery and cytotoxic drugs, we would like to suggest that trastuzumab merits further study as a therapy for EMPD and emphasizes other considerations, such as the clinical importance of obtaining HER-2 status and the possibility of combination therapy.
Personalized irradiation therapy for NMSC by rhenium-188 skin cancer therapy: a long-term retrospective study
Published in Journal of Dermatological Treatment, 2022
Cesidio Cipriani, Maria Desantis, Gerhard Dahlhoff, Shannon D. Brown, Thomas Wendler, Mar Olmeda, Gunilla Pietsch, Bernadette Eberlein
Use of rhenium-188 as a dermatological high-dose-rate brachytherapy for the treatment of basal and squamous cell carcinoma was first described in 2008 (13). It has already been used in a large variety of BCC and SCC forms, from tumors of very large sizes to relapsing or recurrent forms, to multifocal lesions (14). This technique was later employed to treat patients with a histologically confirmed diagnosis of squamous cell carcinoma of the penis (SCCP) with irradiation times that ranged between 30 and 60 min, resulting in the spare of the anatomical integrity of the organ (6). Brachytherapy with rhenium-188 was also selected to treat extramammary Paget’s disease (EMPD) in 15 patients, with a consequent complete healing process (15). Overall, more than 460 patients, with a total of approximately 1300 histologically or clinically confirmed lesions of BCCs and SCCs have been successfully treated to date with the referred epidermal radioisotope therapy. This study provided some clinical data acquired with a long-term follow-up that proves its medical efficiency.
Excision combined with photodynamic therapy for scrotal Paget’s disease in patients aged over 60 years
Published in The Aging Male, 2020
Mingquan Chen, Xiong Chen, Yuanqing Dai, Zhiming Yang, Xiaobo Zhang, Dongjie Li
Cardiovascular disease and diabetes are common in patients of advanced age [31]. The New York Heart Association (NYHA) classification, which provides a simple way of classifying the extent of heart failure [32], and the incidence of diabetes were higher among the patients in our study than in younger people (Table 3). Therefore, it is particularly important to provide comprehensive medical and preventive care services to these patients. The standard treatment of scrotal Paget’s disease is radical resection of skin lesions involving wide surgical excision with a margin of at least 2 cm. However, one study showed well-demarcated lesions of extramammary Paget’s disease can be adequately managed by resection with a 1-cm margin [33]. Based on a comprehensive assessment of comorbidities, we performed wide surgical excision of an area 1 cm distal to the tumor margin combined with ALA PDT to reduce operative trauma and improve the functional status.