10.5826/dpc.1304a223
text/xml
2160-9381
3206
en
Stefano Piaserico
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Photodynamic Therapy for Primary Cutaneous Extramammary Paget Disease
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2023-10-31
2023-02-01
2023-10-31
2024-01-15
e2023223
Dermatol Pract Concept
Stefano Piaserico
2023/10/31
10.5826/dpc.1304a223
e2023223
Department of Dermatology, University of Padua, Italy
2160-9381
en
e2023223
Shim PJ, Zeitouni NC. Photodynamic therapy for extramammary Paget’s disease: A systematic review of the literature. Photodiagnosis Photodyn Ther. 2020;31:101911. DOI: 10.1016/j.pdpdt.2020.101911. PMID: 32645437.References
Photodynamic Therapy for Primary Cutaneous Extramammary Paget Disease
https://dpcj.org/index.php/dpc/article/download/3206/2374
        Photodynamic Therapy for Primary Cutaneous
               Extramammary Paget Disease
        Alberto Meneguzzo1, Roberto Mazzetto1, Annalisa Lazzarotto1, Stefano Piaserico1


1 Department of Dermatology, University of Padua, Italy



Citation: Meneguzzo A, Mazzetto R, Lazzarotto A, Piaserico S. Photodynamic Therapy for Primary Cutaneous Extramammary Paget’s
Disease. Dermatol Pract Concept. 2023;13(4):e2023223. DOI: https://doi.org/10.5826/dpc.1304a223
Accepted: May 3, 2023; Published: October 2023
Copyright: ©2023 Meneguzzo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Roberto Mazzetto, Via Vincenzo Gallucci 4, 35121, Padova (PD), Italy. Tel +393479466312 Email:
robertomazzetto93@gmail.com




Case Presentation                                                        2 weeks with a complete resolution of the cutaneous mani-
                                                                         festation and without any adverse effects or functional im-
A 70-year-old man presented with a slowly growing erythem-               pairments (Figure 1, B and D).
atous scaly plaque on the right inguinal fold (­Figure 1A).
The patient complained about itching and burning. Derma-
                                                                         Teaching Point
toscopic features observed included a milky-red background
with variable vascular patterns, in particular dotted vessels            EMPD is a rare neoplastic disease affecting predominantly
and glomerular vessels with some erosions (Figure 1C).                   patients between 50 to 80 years of age [1]. The current treat-
­Biopsy showed nests of proliferating atypical cells with pag-           ments may include surgery, considered the first-line therapy
etoid spread to the entire epidermis (Figure 1E). Cerium am-             and radiotherapy, imiquimod cream, photodynamic therapy
monium molybdate (CAM) 5.2 stain, marking cytokeratins                   (PDT), topical fluorouracil and carbon dioxide laser therapy.
8 and to a lesser extent cytokeratin 7, highlighted Paget cells          Data for treatment with fluorouracil, carbon dioxide laser,
proliferating in the epidermis and upper dermis (Figure 1F).             and combination topical therapies are limited. In patients
A diagnosis of Extramammary Paget disease (EMPD) was                     unwilling to undergo surgical treatment or who are not sur-
thus made. Thoracic, abdominal, and pelvic computed to-                  gical candidates, PDT may represent an interesting approach
mography scan resulted negative. Also, carcinoembryonic                  to EMPD. In particular, MAL-PDT showed complete clear-
antigen (CEA) and prostate-specific antigen (PSA) were in                ance rate of 27.4 % [2].
the normal range. The patient received 5 sessions of methyl
aminolevulinate photodynamic therapy (MAL-PDT) every




Image Letter | Dermatol Pract Concept. 2023;13(4):e2023223                                                                           1
Figure 1. (A) A slowly growing erythematous scaly plaque on the right inguinal fold: a case of EMPD. (B) Resolution of the cutaneous man-
ifestation after five sessions of MAL-PDT. (C) ­Dermatoscopic features: milky-red background with variable vascular patterns, in particular
dotted vessels and glomerular vessels. (D) Dermatoscopic aspects of the skin after MAL-PDT. (E) Hematoxylin and Eosin stained tissue sec-
tion showed an intraepithelial proliferation of large, round, atypical cells with an abundant, pale mucin-rich cytoplasm (Paget cells), located
in nests along the basement membrane and extending to the entire epidermis, with occasional mitoses. Hyperkeratosis and parakeratosis
overlie the proliferation, and a dermal infiltrate is evident (H&E, 40×). (F) CAM 5.2 stain marks Paget cells proliferating in the epidermis
and upper dermis.


References                                                                2. Shim PJ, Zeitouni NC. Photodynamic therapy for extramam-
                                                                             mary Paget’s disease: A systematic review of the literature. Pho-
 1. Lam C, Funaro D. Extramammary Paget’s Disease: Summary of                todiagnosis Photodyn Ther. 2020;31:101911. DOI: 10.1016/j
    Current Knowledge. Dermatol Clin. 2010;28(4):807–26. DOI:                .pdpdt.2020.101911. PMID: 32645437.References
    10.1016/j.det.2010.08.002. PMID: 20883922.




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