Staged marginal contoured and central excision technique in the surgical management of perianal Paget's disease.
BACKGROUND
Extramammary Paget's disease (EMPD) is an adenocarcinoma of the apocrine glands with unknown exact prevalence and obscure etiology. It has been divided into primary EMPD and secondary EMPD, in which an internal malignancy is usually associated. Treatment for primary EMPD usually consists of wide lesion excision with negative margins. Multiple methods have been proposed to obtain free-margin status of the disease. These include visible border lesion excision, punch biopsies, and micrographic and frozen-section surgery, with different results but still high recurrence rates.


METHODS
The investigators propose a method consisting of a staged contoured marginal excision using "en face" permanent pathologic analysis preceding the steps of central excision of the lesion and the final reconstruction of the surgical defect.


RESULTS
Advantages of this method include adequate margin control allowing final reconstruction and tissue preservation, while minimizing patient discomfort.


CONCLUSIONS
The staged contoured marginal and central excision technique offers a new alternative to the armamentarium for surgical oncologists for the management of EMPD in which margin control is imperative for control of recurrence rates.
DeWitt Daughtry Family Department of Surgery, Division of Surgical Oncology, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 410U, Miami, FL 33136, USA. Electronic address: mmoller@med.miami.edu.
Mecker G
MG
Möller
Miami Transplant Institute, Jackson Memorial Hospital, University of Miami, Miami, FL, USA.
Jose Alejandro
JA
Lugo-Baruqui
Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, USA.
Clara
C
Milikowski
DeWitt Daughtry Family Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Christopher J
CJ
Salgado
D000369:Aged, 80 and over; D000694:Anal Gland Neoplasms / Q000175:diagnosis / Q000601:surgery*; D001706:Biopsy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010145:Paget Disease, Extramammary / Q000175:diagnosis / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D013514:Surgical Procedures, Operative / Q000379:methods*; D014057:Tomography, X-Ray Computed
Clear margins; Extramammary Paget's disease; Marginal contoured excision; Perineal; Surgical management