Extramammary Paget Disease Medication
- Author: Neil Sandhu, MD; Chief Editor: Dirk M Elston, MD more...
Medication Summary
Topical imiquimod is considered a possible treatment option, when surgery is a challenge or contraindicated. However, more studies are needed to confirm the use of topical therapies for patients with extramammary Paget disease (EMPD).
Fluorouracil is used topically. It interferes with DNA synthesis by blocking methylation of deoxyuridylic acid via inhibition of thymidylate synthetase and, subsequently, cell proliferation. For lesions on bald scalp or extremities, longer treatment is often necessary.
Immunomodulators
Class Summary
These agents modulate key factors of the immune system.
Imiquimod (Aldara, Zyclara)
Immune response modifier with an unknown mechanism of action. Indicated to treat clinically typical, nonhyperkeratotic, nonhypertrophic actinic keratoses on the face or scalp.
Antineoplastics, Antimetabolite
Class Summary
These agents inhibit cell growth and proliferation.
Fluorouracil (Carac, Efudex, Fluoroplex)
Fluorouracil is used topically. It interferes with DNA synthesis by blocking methylation of deoxyuridylic acid via inhibition of thymidylate synthetase and, subsequently, cell proliferation. For lesions on bald scalp or extremities, longer treatment is often necessary.
Roy J, Mirnezami A, Gatt M, Sasapu K, Scott N, Sagar P. A rare case of Paget's disease in a retrorectal dermoid cyst. Colorectal Dis. Nov 2 2009;[Medline].
Chanda JJ. Extramammary Paget's disease: prognosis and relationship to internal malignancy. J Am Acad Dermatol. Dec 1985;13(6):1009-14. [Medline].
Bagby CM, MacLennan GT. Extramammary Paget's disease of the penis and scrotum. J Urol. Dec 2009;182(6):2908-9. [Medline].
Cho SB, Yun M, Lee MG, Chung KY. Variable patterns of positron emission tomography in the assessment of patients with extramammary Paget's disease. J Am Acad Dermatol. Feb 2005;52(2):353-5. [Medline].
D'Agostino M, Cinelli C, Willard R, Hofmann J, Jellinek N, Robinson-Bostom L. Epidermotropic Merkel cell carcinoma: a case series with histopathologic examination. J Am Acad Dermatol. Mar 2010;62(3):463-8. [Medline].
Perrotto J, Abbott JJ, Ceilley RI, Ahmed I. The Role of Immunohistochemistry in Discriminating Primary From Secondary Extramammary Paget Disease. Am J Dermatopathol. Jan 4 2010;[Medline].
Beleznay KM, Levesque MA, Gill S. Response to 5-fluorouracil in metastatic extramammary Paget disease of the scrotum presenting as pancytopenia and back pain. Curr Oncol. Sep 2009;16(5):81-3. [Medline].
Sendagorta E, Herranz P, Feito M, et al. Successful treatment of three cases of primary extramammary Paget's disease of the vulva with Imiquimod - proposal of a therapeutic schedule. J Eur Acad Dermatol Venereol. Oct 15 2009;[Medline].
Takahagi S, Noda H, Kamegashira A, et al. Metastatic extramammary Paget's disease treated with paclitaxel and trastuzumab combination chemotherapy. J Dermatol. Aug 2009;36(8):457-61. [Medline].
Cecchi R, Pavesi M, Bartoli L, Brunetti L, Rapicano V. Perineal extramammary Paget disease responsive to topical imiquimod. J Dtsch Dermatol Ges. Jan 2010;8(1):38-40. [Medline].
Appert DL, Otley CC, Phillips PK, Roenigk RK. Role of multiple scouting biopsies before Mohs micrographic surgery for extramammary Paget's disease. Dermatol Surg. Nov 2005;31(11 Pt 1):1417-22. [Medline].
Coldiron BM, Goldsmith BA, Robinson JK. Surgical treatment of extramammary Paget's disease. A report of six cases and a reexamination of Mohs micrographic surgery compared with conventional surgical excision. Cancer. Feb 15 1991;67(4):933-8. [Medline].
Hendi A, Brodland DG, Zitelli JA. Extramammary Paget's disease: surgical treatment with Mohs micrographic surgery. J Am Acad Dermatol. Nov 2004;51(5):767-73. [Medline].

