title: A therapeutic approach to perianal extramammary Paget's disease: topical imiquimod can be useful to prevent or defer surgery.
abstract: 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.
authors.affiliation: Departments of Dermatology, CHU-Brugmann Hospital, Brussels, Belgium. pierre.vereecken@chu-brugmann.be
authors.forename: Pierre
authors.initials: P
authors.lastname: Vereecken
authors.forename: Ahmad
authors.initials: A
authors.lastname: Awada
authors.forename: Ghanem
authors.initials: G
authors.lastname: Ghanem
authors.forename: Claudia
authors.initials: C
authors.lastname: Marques da Costa
authors.forename: Denis
authors.initials: D
authors.lastname: Larsimont
authors.forename: Christian
authors.initials: C
authors.lastname: Simoens
authors.forename: Pierre
authors.initials: P
authors.lastname: Mendes da Costa
authors.forename: Alain
authors.initials: A
authors.lastname: Hendlisz
mesh_terms: 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*
chemical_list: D000634:Aminoquinolines; D000970:Antineoplastic Agents; D000077271:Imiquimod