title: Complete remission of two patients with recurrent and wide spread extramammary Paget disease obtained from 5-aminolevulinic acid-based photodynamic therapy and imiquimod combination treatment.
abstract: BACKGROUND
  Extramammary Paget disease (EMPD) is an uncommon malignant neoplasm affecting apocrine gland-bearing skin which usually occurs in the anogenital area of patients older than 50 years. However, as EMPD in old men develops in penoscrotal area and sometimes asymptomatic, in situ or dermal invasion is usually widely spread before a confirmed diagnosis was made. Skin graft is needed after surgery. Both photodynamic therapy (PDT) and topical use of imiquimod reported effective for EMPD.
  
  
  METHODS
  Two patients with recurrent and wide spread at penoscrotal and groin area were diagnosed EMPD by biopsy and histopathological and immunohistochemical examination. We use 6 cycles of 20% 5-aminolevulinic acid (ALA) photodynamic therapy guided by 5-ALA induced porphyrin fluorescence. After PDT, patients were treated by topical use of imiquimod to prevent the recurrence.
  
  
  RESULTS
  After 6 cycles of PDT and imiquimod treatments, the patients' examination showed total remission. At the end of the 6 and 12 months, biopsy and pathology examination remain no signal of recurrence. No clinical recurrence after 24 and 36 months' follow up.
  
  
  CONCLUSIONS
  The combination treatment with 20% PDT and imiquimod acquired complete remission in treatment for recurrent and wide spread extramammary Paget disease in two patients.
authors.affiliation: The Fourth People's Hospital of Shenzhen (Futian People's Hospital), China. Electronic address: jwangray@vip.tom.com.
authors.forename: Wang
authors.initials: W
authors.lastname: Jing
authors.affiliation: Institute of Dermatology for Immune Disease and STD, Guangdong Medical College, China.
authors.forename: Xu
authors.initials: X
authors.lastname: Juan
authors.affiliation: The Fourth People's Hospital of Shenzhen (Futian People's Hospital), China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Li
authors.affiliation: The Fourth People's Hospital of Shenzhen (Futian People's Hospital), China.
authors.forename: Chen
authors.initials: C
authors.lastname: Jiayuan
authors.affiliation: The Fourth People's Hospital of Shenzhen (Futian People's Hospital), China.
authors.forename: He
authors.initials: H
authors.lastname: Qin
authors.affiliation: The Fourth People's Hospital of Shenzhen (Futian People's Hospital), China.
authors.forename: Li
authors.initials: L
authors.lastname: Qing
authors.affiliation: The Fourth People's Hospital of Shenzhen (Futian People's Hospital), China.
authors.forename: Xu
authors.initials: X
authors.lastname: Shengmei
mesh_terms: D000368:Aged; D000622:Aminolevulinic Acid / Q000008:administration & dosage*; D000634:Aminoquinolines / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005834:Genital Neoplasms, Male / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D000077271:Imiquimod; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology; D010145:Paget Disease, Extramammary / Q000188:drug therapy* / Q000473:pathology; D017319:Photosensitizing Agents / Q000008:administration & dosage; D012074:Remission Induction; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D000634:Aminoquinolines; D000970:Antineoplastic Agents; D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid; D000077271:Imiquimod
keywords: Extramammary therapy; Imiquimod; Paget disease; Photochemotherapy