title: Paget's Disease of the Vulva Treated with Imiquimod: Case Report and Systematic Review of the Literature.
abstract: BACKGROUND
  Extramammary Paget's disease of the vulva (EPDV) is a rare adenocarcinoma in situ of the vulvar skin and is often resected with involved margins due to its reticular growth pattern. Adjuvant treatment with the immunomodulator imiquimod may be suitable to avoid repeated and mutilating surgery.
  
  
  METHODS
  We present the case of a 73-year-old woman with EPDV, initially treated with surgical resection and re-resection for involved margins. Final histology revealed Paget's disease of the left vulva with 8 cm in the largest diameter and again involved margins. Subsequently, topical therapy with imiquimod 5% cream twice weekly was applied for 3 months. Vulvoscopy and local biopsies confirmed complete remission (CR). Based on a literature search using PubMed and the Cochrane Central Register of Controlled Trials, 21 reports on the therapeutic efficacy of imiquimod in 70 women with EPDV have been published. Pooled rates of CR and partial remission were 71% (50/70) and 16% (11/70), respectively. There were 4 cases of disease progression under imiquimod and the therapy was generally well tolerated with mild to moderate local reactions in >50% of cases.
  
  
  CONCLUSIONS
  EPDV is a rare genital neoplasia and may be successfully treated with the topical immunomodulator imiquimod. Specifically, adjuvant imiquimod is a feasible and efficacious treatment option for women with involved resection margins after surgery.
authors.affiliation: Department of Obstetrics and Gynecology, Ruhr University Bochum, Bochum, Germany.
authors.forename: Askin
authors.initials: A
authors.lastname: Dogan
authors.forename: Ziad
authors.initials: Z
authors.lastname: Hilal
authors.forename: Harald
authors.initials: H
authors.lastname: Krentel
authors.forename: Cem
authors.initials: C
authors.lastname: Cetin
authors.forename: Lukas A
authors.initials: LA
authors.lastname: Hefler
authors.forename: Christoph
authors.initials: C
authors.lastname: Grimm
authors.forename: Clemens B
authors.initials: CB
authors.lastname: Tempfer
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage*; D000287:Administration, Topical; D000634:Aminoquinolines / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D000077271:Imiquimod; D010145:Paget Disease, Extramammary / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D063465:Skin Cream / Q000008:administration & dosage; D014846:Vulvar Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery
chemical_list: D000276:Adjuvants, Immunologic; D000634:Aminoquinolines; D000970:Antineoplastic Agents; D000077271:Imiquimod