Staged marginal contoured and central excision technique in the surgical management of perianal Paget's disease

Abstract Background Extramammary Paget's disease (EMPD) is an adenocarcinoma of the apocrine glands with unknown exact prevalence and obscure etiology. It has been divided into primary EMPD and secondary EMPD, in which an internal malignancy is usually associated. Treatment for primary EMPD usu...

Full description

Saved in:
Bibliographic Details
Published in:The American journal of surgery 2014-04, Vol.207 (4), p.485-492
Main Authors: Möller, Mecker G., M.D, Lugo-Baruqui, Jose Alejandro, M.D, Milikowski, Clara, M.D, Salgado, Christopher J., M.D
Format: Article
Language:English
Subjects:
Aged, 80 and over
Anal Gland Neoplasms - diagnosis
Anal Gland Neoplasms - surgery
Biopsy
Chemotherapy
Classification
Clear margins
Extramammary Paget's disease
Follow-Up Studies
Humans
Male
Marginal contoured excision
Melanoma
Paget Disease, Extramammary - diagnosis
Paget Disease, Extramammary - surgery
Perineal
Radiation therapy
Reconstructive Surgical Procedures - methods
Skin cancer
Surgery
Surgical management
Surgical Procedures, Operative - methods
Tomography, X-Ray Computed
Tumors
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract Background Extramammary Paget's disease (EMPD) is an adenocarcinoma of the apocrine glands with unknown exact prevalence and obscure etiology. It has been divided into primary EMPD and secondary EMPD, in which an internal malignancy is usually associated. Treatment for primary EMPD usually consists of wide lesion excision with negative margins. Multiple methods have been proposed to obtain free-margin status of the disease. These include visible border lesion excision, punch biopsies, and micrographic and frozen-section surgery, with different results but still high recurrence rates. Methods The investigators propose a method consisting of a staged contoured marginal excision using “en face” permanent pathologic analysis preceding the steps of central excision of the lesion and the final reconstruction of the surgical defect. Results Advantages of this method include adequate margin control allowing final reconstruction and tissue preservation, while minimizing patient discomfort. Conclusions The staged contoured marginal and central excision technique offers a new alternative to the armamentarium for surgical oncologists for the management of EMPD in which margin control is imperative for control of recurrence rates.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2013.04.005