A therapeutic approach to perianal extramammary Paget's disease: topical imiquimod can be useful to prevent or defer surgery.
BACKGROUND
Extramammary Paget's disease (EMPD) is a rare skin disease which can be limited to the epidermis and can sometimes also be associated with underlying carcinomas. At clinical examination, lesions are well-defined eczematous areas and have been described typically in the anogenital region. Surgery is the cornerstone treatment.


METHODS
In this report the case of a 66-year-old patient presenting with a long-lasting EMPD of perianal region without deep gastrointestinal neoplasia is described. Because of the extension of the lesion, surgery should have led to abdominoperineal amputation, but the patient rejected this option. Three months of daily application of topical imiquimod was prescribed as an alternative treatment. Biopsy-confirmed complete regression could be observed thereafter, and no recurrence has been noted during a 12-month follow-up.


CONCLUSIONS
This successful treatment of a perianal-located EMPD by topical imiquimod warrants further investigations.
Vereecken
Pierre
P
Departments of Dermatology, CHU-Brugmann Hospital, Brussels, Belgium. pierre.vereecken@chu-brugmann.be
Awada
Ahmad
A
Ghanem
Ghanem
G
Marques da Costa
Claudia
C
Larsimont
Denis
D
Simoens
Christian
C
Mendes da Costa
Pierre
P
Hendlisz
Alain
A
D000287:Administration, Topical; D000368:Aged; D000634:Aminoquinolines / Q000008:administration & dosage* / Q000627:therapeutic use*; D001003:Anal Canal / Q000473:pathology; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D006801:Humans; D000077271:Imiquimod; D008297:Male; D010145:Paget Disease, Extramammary / Q000188:drug therapy*; D012878:Skin Neoplasms / Q000188:drug therapy*
D000634:Aminoquinolines; D000970:Antineoplastic Agents; D000077271:Imiquimod