title: Treatment of mammary and extramammary Paget's skin disease with topical imiquimod.
abstract: BACKGROUND
  Paget's disease is an uncommon epidermal cancer, affecting all skin regions wherever apocrine glands are present. It is divided into extramammary (EMPD) and mammary Paget's disease (MPD). It can be confined to the epithelium or may be associated with an underlying adenocarcinoma. The diagnosis is confirmed by skin biopsy and the treatment depends on characteristics of the underlying cancer. Surgery is the first-line treatment. Imiquimod, a topical immunomodulator, approved its efficiency in several skin neoplasms and has been shown as a safe treatment for EMPD. However, it has never been reported for the treatment of MPD.
  
  
  METHODS
  We report on two cases of EMPD and MPD successfully treated with imiquimod 5% cream.
  
  
  CONCLUSIONS
  This non-surgical method may be considered as a primary treatment when Paget's disease is not associated with an underlying malignancy. The good prognosis with a long-term survival, the anatomic localization and the poor general condition of elderly people may favor imiquimod as an alternative treatment. On the other hand, it will reduce the extent of excision when it anticipates surgery.
authors.affiliation: Department of Dermatology, CHU Purpan, Toulouse, France. ewa.mirer@tele2.fr
authors.forename: Ewa
authors.initials: E
authors.lastname: Mirer
authors.forename: Fouad
authors.initials: F
authors.lastname: El Sayed
authors.forename: Alfred
authors.initials: A
authors.lastname: Ammoury
authors.forename: Laurence
authors.initials: L
authors.lastname: Lamant
authors.forename: Line
authors.initials: L
authors.lastname: Messer
authors.forename: Jacques
authors.initials: J
authors.lastname: Bazex
mesh_terms: D000279:Administration, Cutaneous; D000368:Aged; D000369:Aged, 80 and over; D000634:Aminoquinolines / Q000008:administration & dosage / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006119:Groin; D006801:Humans; D000077271:Imiquimod; D010145:Paget Disease, Extramammary / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D010144:Paget's Disease, Mammary / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D012878:Skin Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology
chemical_list: D000634:Aminoquinolines; D000970:Antineoplastic Agents; D000077271:Imiquimod