Treatment of mammary and extramammary Paget's skin disease with topical imiquimod.
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.
Mirer
Ewa
E
Department of Dermatology, CHU Purpan, Toulouse, France. ewa.mirer@tele2.fr
El Sayed
Fouad
F
Ammoury
Alfred
A
Lamant
Laurence
L
Messer
Line
L
Bazex
Jacques
J
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
D000634:Aminoquinolines; D000970:Antineoplastic Agents; D000077271:Imiquimod