Introduction Extramammary Paget’s disease (EMPD) of the vulva is a rare form of intra epithelial adenocarcinoma, which is most common in postmenopausal women. The gold standard treatment for non-invasive EMPD vulva is wide local excision. Surgery is challenging in elderly women with multiple comorbidities. Imiquimod, a topical immune response modifier is a new treatment modality with encouraging results.

Methods Retrospective analysis Objective is to retrospectively investigate the efficacy of 5% imiquimod cream in patients with non-invasive vulvar Paget disease both primary and recurrent.

Current Trial Status Results IRB permission and individual consent for photo documentation was available for all patients. Data were available for 22 patients with complete clinical, histological and photo documentation. Thirteen patients (59%) were treated for primary EMPD, and 9 patients (44.4%) were treated for recurrent EMPD. A complete response was reported in 11 patients (50%), and 11 patients (50%) had a partial response. A histologic complete response was observed in 5 of the 11 patients with a complete response. Duration of use of imiquimod was 12 to 28 weeks. No systemic side effects noted in any patient. Local irritation was noted and documented in 6 patients. Lesion size was noted less than 8 cm in patients with complete clinical response. Extensive lesions extending to groin folds and perinium responded partially. conclusion Topical 5% imiquimod cream can be an effective and safe treatment alternative for small volume non-invasive vulvar EMPD.