title: Clinicopathological study of invasive extramammary Paget's disease: subgroup comparison according to invasion depth.
abstract: BACKGROUND
  Extramammary Paget's disease (EMPD) is a distinct form of malignant skin neoplasm. Invasive EMPD is relatively rare and its detailed histopathological features have not been investigated to date.
  
  
  METHODS
  Surgical specimens were obtained from 51 patients with primary invasive EMPD. Clinical data including lymph node status were retrieved from the patients' medical records. Cases were divided into subgroups according to invasion depth: dermal invasion ≤ 1 mm (minimal invasion) and dermal invasion > 1 mm in depth. Histological patterns (nodular/glandular pattern or micronodular pattern), lymphatic/venous invasion, mitosis and lymph node status were compared between the two groups.
  
  
  RESULTS
  The invasive EMPDs included 26 cases (51.0%) with dermal invasion ≤ 1 mm (minimal invasion) and 25 cases (49.0%) with dermal invasion > 1 mm in depth. Lymph node metastasis was detected in 2/26 (7.7%) patients with minimally invasive EMPD. Nodular/glandular pattern (72.0%), lymphatic/venous invasion (52.0%), mitosis (88.0%) and nodal metastasis (88.0%) were all significantly more frequent in cases with dermal invasion > 1 mm, compared to EMPDs with dermal invasion ≤ 1 mm (minimal invasion) (P < 0.001).
  
  
  CONCLUSIONS
  These results suggest that invasive EMPD can be divided according to invasion depth, with a cut-off depth of 1 mm. This might represent the basis for a useful, EMPD-specific staging system.
authors.affiliation: Department of Organ Pathology, Tottori University, Faculty of Medicine, Yonago, Japan. shiomi@grape.med.tottori-u.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Shiomi
authors.forename: T
authors.initials: T
authors.lastname: Noguchi
authors.forename: H
authors.initials: H
authors.lastname: Nakayama
authors.forename: Y
authors.initials: Y
authors.lastname: Yoshida
authors.forename: O
authors.initials: O
authors.lastname: Yamamoto
authors.forename: N
authors.initials: N
authors.lastname: Hayashi
authors.forename: K
authors.initials: K
authors.lastname: Ohara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010145:Paget Disease, Extramammary / Q000473:pathology*