A Primer on Extramammary Paget's Disease for the Urologist

Joon Yau Leong; Paul H. Chung


Transl Androl Urol. 2020;9(1):93-105. 

In This Article

Investigations and Diagnostic Evaluation

A thorough history and physical examination should be performed with special attention to the location, distribution, size, color and morphology of the EMPD lesion. Palpation for enlarged lymph nodes and hepatosplenomegaly should be performed with a breast, pelvic and digital rectal exam as indicated. A biopsy of the lesion should be performed if not done so already. Pathology should be reviewed for factors such as dermal invasion which portends a higher risk of adverse prognosis.[18,32,45]

A comprehensive laboratory workup, including serum carcinoembryonic antigen (CEA) levels should be obtained. Cross-sectional imaging of the abdomen and pelvis may be performed to evaluate for nodal or metastatic disease. Screening for associated internal malignancies, such as cervical, colorectal, bladder and prostate may be done as clinically indicated with Pap smear, colonoscopy, cystoscopy and serum prostate-specific antigen, respectively. If patients have lapsed the recommended screening intervals, respective specialty referral may be warranted.[46]