Clinical Study Of Combined Surgery And Photodynamic Therapy For Extramammary Paget Disease

Background: The pathogenesis of Extramammary Paget Disease(EMPD)is not clear.It mainly originated from undifferentiated pluripotent cells of epidermis and/or its adnexa or be derived from the cells of the apocrine duct,even multifocal origin.The Paget cells often showed multifocal or finger growth.EMPD often occurred in the scrotum,penis,vulva area,and the lesions are extensive.Wide excision repair after surgery is difficult.And EMPD recurrence rate was significantly higher than other skin malignant tumors.With the improvement of people's understanding of disease and the increase of the quality of life,the choice of treatment methods is becoming more and more diverse.People also seek to find some new treatment methods,high cure rate,high safety,repeatability,less side effects and so on.Photodynamic therapy is a new treatment for non-melanocytic skin tumors.It has good selectivity,good safety,and not affected by tumor size,location restrictions,do not cause resistance reaction,no scar and other side effects.It has become one of the standard therapies for solar keratosis,Bowen disease,superficial basal cell carcinoma and other skin tumors.The choice of treatment for EMPD depends on the location of the tumor,the extent of the invasion,and the patient's general condition.Although surgery is the main medical methods of skin tumor treatment,the increasingly updated non-surgical treatments,such as photodynamic therapy,have greatly improved the patient's life,and prognosis.Objective: to investigate the effect of combined surgery and photodynamic therapy(PDT)in the treatment of extramammary paget disease.To analyze the clinical and pathological features of EMPD.Methods: 38 patients which were diagnosed the primary extramammary paget disease by pathological biopsy and immunohistochemistry were assigned to surgery group(n=21)or surgery+PDT group(n=17).For the surgery group: a traditional surgery of the tumor with 1cm margin was performed.For the surgery+PDT group:topical PDT mediated with 20% 5-aminolevulinic acid(ALA-PDT)were applied after surgery,once every two weeks,a total of three times.All patients were followed up for more than 12 months.Results: ? The recurrence rate was 33.3%(7/21)in surgery group and 5.9%(1/17)in the combination group(p<0.05).? The median time to relapse was nine months in surgery group.Time to relapse was 18 months after the treatment in the combination group.The recurrence time was longer in the combination group than in surgery group.? Further more,all patients were able to tolerate pain during photodynamic therapy after surgery.Conclusions: The early diagnosis of extramammary paget disease is difficult and the recurrence rate is high.Long-term follow-up is needed after treatment.Combined surgery and PDT can reduce the recurrence rate and prolong the recurrence time of extramammary paget disease.Patients can withstand the pain of photodynamic after surgery.So the patient's compliance increased and the prognosis of patients improved.