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

Treatment and Management

A recent online questionnaire queried an international cohort and identified that EMPD is treated by a variety of providers using an array of treatment modalities. These phenomena pose a challenge to developing guidelines for diagnosis, management and follow-up.[18] Currently, a few invasive and non-invasive treatment options exist for EMPD with limited head-to-head comparisons. In fact, there is only one existing clinical trial evaluating the safety and efficacy of topical imiquimod cream for non-invasive vulvar Paget's disease (NCT02385188).[47] Other non-invasive treatments include radiation and chemotherapy, laser therapy or photodynamic therapy while the more invasive approaches include Mohs micrographic surgery (MMS) and wide local excision (WLE). Table 1 summarizes the response and recurrence rates for non-invasive treatment options while Figure 2 depicts the advantages and disadvantages of the main treatment modalities for EMPD.

Figure 2.

Advantages and disadvantages of Mohs micrographic surgery, wide local excision, and non-surgical therapy for EMPD. EMPD, extramammary Paget's disease.