title: Mohs micrographic surgery for extramammary Paget disease: a pooled analysis of individual patient data.
abstract: BACKGROUND
  Extramammary Paget disease (EMPD) is a rare intraepithelial neoplasm of the skin characterized by ill-defined margins and high recurrence rates after wide local excision. Although Mohs micrographic surgery (MMS) has been proposed to decrease the rate of local recurrence, the efficacy of MMS for this condition has not yet been established.
  
  
  OBJECTIVE
  We sought to assess the efficacy of MMS for the treatment of EMPD.
  
  
  METHODS
  A comprehensive systematic review and individual patient data meta-analysis was performed including all available clinical studies and case reports with 5 or more subjects describing the use of MMS for EMPD.
  
  
  RESULTS
  Eight studies were identified and included in the current review: 3 retrospective studies and 5 case series. In all, 81 patients with 90 cases of MMS were included from these 8 studies. The overall recurrence rate for EMPD after MMS was 12.2% correlating with an estimated 5-year tumor-free rate of 83.6% by using Kaplan-Meier curve analysis. The treatment of EMPD with MMS resulted in significantly lower recurrence rates than wide local excision in this meta-analysis of 3 observational studies with comparators (odds ratio 0.20; 95% confidence interval 0.05-0.81).
  
  
  CONCLUSIONS
  Limitations include lack of controlled trials, small sample sizes in the included studies, and publication bias.
  
  
  CONCLUSIONS
  The current evidence supports the efficacy of MMS in the treatment of EMPD. Further controlled clinical trials are needed.
authors: Department of Dermatology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors: Jung Min
authors: JM
authors: Bae
authors: Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors: Yoon Young
authors: YY
authors: Choi
authors: Department of Dermatology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors: Heesu
authors: H
authors: Kim
authors: Department of Dermatology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors: Byung Ho
authors: BH
authors: Oh
authors: Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea; Department of Dermatology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors: Mi Ryung
authors: MR
authors: Roh
authors: Department of Dermatology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors: KyoungAe
authors: K
authors: Nam
authors: Department of Dermatology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea; Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea. Electronic address: kychung@yuhs.ac.
authors: Kee Yang
authors: KY
authors: Chung
mesh_terms: D006801:Humans; D015580:Mohs Surgery; D010145:Paget Disease, Extramammary / Q000601:surgery*; D016896:Treatment Outcome