Article Text

Download PDFPDF

60 Recurrent paget’s disease of the vulva in a split-thickness graft
Free
  1. R Imperio-Onglao and
  2. J Luna
  1. Philippine general hospital, philippines

Abstract

Introduction Intraepithelial Extramammary Paget’s disease (EMPD) of the vulva is a rare neoplasm with high rates of recurrence. EMPD in a split-thickness skin graft, is associated with retrodissemination or spread of the disease within the skin via lymphatics and vessels creating tissue bridges between sites of involvement.

We present a case of an 81-year-old Asian female, with complaints of vulvar pruritus and lesion at the left inguinal. Enlargement of the lesion prompted a vulvar punch biopsy which showed Paget’s disease. Wide local excision with split-thickness skin grafting was performed. One-year post-operation, vulvar lesions on the split-thickness graft were noted. Biopsy showed Extramammary Paget’s Disease recurrence. Patient underwent repeat wide local excision with frozen section, and split-thickness skin grafting. After 6 months post re-excision, patient noted vulvar lesions and repeat biopsy showed Extramammary Paget’s Disease recurrence. Due to the proximity of the lesion to the sphincter and need for a colostomy, the patient did not consent for re-excision. Imiquimod 5% was chosen as the mode of treatment.

Conclusion Retrodissemination is hypothesized as the etiology of Paget’s spread in a split-thickness skin graft. Surgical challenges include removing the disease that may not be visible and minimizing morbidity from radical surgery. Imiquimod 5% can be used in recurrences. Despite the advances in the knowledge of EMPD of the vulva, the high rate of recurrent disease remains a challenge for optimal management and would require frequent and long-term follow-up.

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.