A prospective pilot study to evaluate combined topical photodynamic therapy and surgery for extramammary paget's disease

• Published in: Lasers in surgery and medicine 2013-07, Vol.45 (5), p.296-301
• Main Authors: Wang, Hong-wei, Lv, Ting, Zhang, Ling-lin, Lai, Yong-xian, Tang, Li, Tang, Yi-chen, Huang, Zheng, Wang, Xiu-li
• Format: Article
• Language: English
• Subjects: Administration, Topical; Aged; Aged, 80 and over; ALA; Aminolevulinic Acid - administration & dosage; Cohort Studies; Combined Modality Therapy; EMPD; extramammary Paget's disease; Feasibility Studies; Female; fluorescence imaging; Humans; Lasers; Male; Middle Aged; Paget Disease, Extramammary - pathology; Paget Disease, Extramammary - therapy; Patient Satisfaction; PDT; Photochemotherapy; Photosensitizing Agents - administration & dosage; Pilot Projects; Prospective Studies; Skin Neoplasms - pathology; Skin Neoplasms - therapy; surgery; Treatment Outcome
• ISSN: 0196-8092; 1096-9101
• DOI: 10.1002/lsm.22142

Background and objective Extramammary Paget's disease (EMPD) is a rare intra‐epithelial neoplasm. Surgical excision is the treatment of choice. The usefulness of topical photodynamic therapy (PDT) in the treatment of EMPD has been reported. The objective of this prospective pilot study was to investigate the feasibility of combined PDT and surgery in the treatment of EMPD. Subjects and Methods A total of 13 patients with 19 large EMPD lesions were recruited and assigned to surgery (n = 5) or PDT + surgery (n = 8) group. For the PDT + surgery group, four sessions of topical PDT mediated with 20% 5‐aminolevulinic acid (ALA‐PDT) were applied prior to surgery. Patients were followed up for 12 months. Treatment outcomes, adverse reactions and recurrence were compared. Results In the surgery group, recurrence was seen in 2 out of 8 lesions (25%). In the combination group, over 58% reduction in lesion size was achieved after 4‐sessions of PDT and recurrence was seen in 1 out of 11 lesions (9.1%) after surgery. Conclusions Multiple ALA‐PDT could be applied to reduce the severity of EMPD lesion and improve the success of surgery. Lasers Surg. Med. 45:296–301, 2013. © 2013 Wiley Periodicals, Inc.