title: Management of extramammary Paget's disease with a staged, modified Mohs technique.
abstract: Extramammary Paget's disease (EMPD) is a rare intraepithelial adenocarcinoma arising from apocrine glands. We describe an innovative surgical technique to manage extensive cutaneous malignancies in a notoriously challenging location. The patient is a 78-year-old male who presented with 'jock itch' on his left groin refractory to topical treatment. A shave biopsy of the lesion demonstrated non-invasive EMPD which yielded a urology consult. Rather than the standard wide local excision (WLE), which can lead to positive margins, progression, and recurrence, we used a modified the Mohs technique and staged the procedure, providing excellent oncologic and cosmetic outcomes. The described technique has particular merit with uncertain margin status and when geography of lesions preclude a standard Mohs surgery.
authors.affiliation: Department of Urology, Madigan Army Medical Center, Tacoma, Washington, USA.
authors.forename: Anant
authors.initials: A
authors.lastname: Shukla
authors.forename: Matthew
authors.initials: M
authors.lastname: Stringer
authors.forename: Pansy
authors.initials: P
authors.lastname: Uberoi
authors.forename: Steven
authors.initials: S
authors.lastname: Hudak
authors.forename: George
authors.initials: G
authors.lastname: Kallingal
mesh_terms: D000368:Aged; D001706:Biopsy / Q000379:methods; D002278:Carcinoma in Situ / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D006119:Groin / Q000473:pathology; D006801:Humans; D008297:Male; D015580:Mohs Surgery / Q000379:methods*; D010145:Paget Disease, Extramammary / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome