Treatment of recurrent vulvar Paget disease with imiquimod cream: a case report and review of the literature.
BACKGROUND
Extra-mammary Paget disease is one of the rare neoplastic conditions of the skin. The most common site of involvement is the vulva and presents itself with erythematous plaques. Surgery is the most important treatment option. In the recent years, there are publications of the topical use of imiquimod cream in extra-mammary cutaneous Paget disease. We report the case of a woman with recurrent vulvar Paget disease, who underwent successful treatment with imiquimod cream. We also review the reports of other patients with vulvar Paget disease who were treated with topical imiquimod cream.


METHODS
A 65-year-old woman presented to the Oncology Outpatient Clinic with an itchy lesion in her vulva for 2 years. In the gynecologic examination, a hyperkeratotic erythematous lesion was found starting from the right labium to involve clitoris, with a size of 4 × 3 cm. Pathology result was reported as Paget disease. She was operated and wide vulvar excision was performed with a safety margin of 2 cm. Then recurrence two times occurred. Because she refused surgery, imiquimod cream 5% was applied for treatment.


CONCLUSIONS
Imiquimod cream is an effective and safe therapeutic agent for both primary and recurring vulvar Paget disease.
Tonguc
Esra
E
Department of Oncology, Zekai Tahir Burak Women's Health Research and Education Hospital, Tunali Hilmi Cad. Binnaz Sok. No:1/5 Kavaklidere, Ankara, Turkey. esratonguc@yahoo.com
Güngor
Tayfun
T
Var
Turgut
T
Ozat
Mustafa
M
Sahin
Izzet
I
Sirvan
Levent
L
D000368:Aged; D000634:Aminoquinolines / Q000009:adverse effects / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001623:Betamethasone / Q000627:therapeutic use; D004643:Emollients / Q000627:therapeutic use; D005260:Female; D006801:Humans; D000077271:Imiquimod; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D010145:Paget Disease, Extramammary / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D014846:Vulvar Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery
D000634:Aminoquinolines; D000970:Antineoplastic Agents; D004643:Emollients; D001623:Betamethasone; D000077271:Imiquimod
Gynecol Oncol. 2001 Dec;83(3):599-600
11733979
Cancer Treat Rev. 2010 Apr;36(2):101-9
20015593
Lancet Oncol. 2004 May;5(5):283-91
15120665
Gynecol Oncol. 2004 Aug;94(2):600-4
15297214
Clin Breast Cancer. 2004 Oct;5(4):317-9
15507181
J Reprod Med. 1998 Apr;43(4):387-92
9583073
Gynecol Oncol. 2005 May;97(2):693-6
15863184
Int J Gynecol Cancer. 2006 Jan-Feb;16(1):8-15
16445603
Eur J Obstet Gynecol Reprod Biol. 2007 Apr;131(2):238-9
16698170
Int J Gynecol Cancer. 2007 Sep-Oct;17(5):1140-3
17433066
Arch Gynecol Obstet. 2007 Aug;276(2):179-83
17342499
Int J Gynecol Cancer. 2008 Jan-Feb;18(1):181-4
17466045
Clin Transl Oncol. 2008 Jun;10(6):375-6
18558586
Cancer. 2008 Dec 1;113(11):3069-74
18985677
Int J Gynecol Cancer. 2009 May;19 Suppl 1:S1-12
19509538
Arch Gynecol Obstet. 2009 Oct;280(4):633-6
19205713
Arch Gynecol Obstet. 2009 Nov;280(5):823-5
19242705
Eur J Obstet Gynecol Reprod Biol. 2010 Mar;149(1):18-21
20042265
Best Pract Res Clin Obstet Gynaecol. 2010 Feb;24(1):61-79
19740709
Obstet Gynecol. 2003 Nov;102(5 Pt 2):1200-2
14607056