Transactions of the Sixty-fourth Annual Meeting of the South Atlantic Association of Obstetricians and Gynecologists
Paget's disease of the vulva

Presented at the annual meeting of the South Atlantic Association of Obstetricians and Gynecologists, St. Petersburg, Florida, January 27-30, 2002.
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Abstract

Objective: Our goal was to review our experience with Paget's disease of the vulva relative to initial examination, treatment, and oncologic outcome. Study Design: Patients who were treated for extramammary Paget's disease of the vulva at the University of South Florida were identified in our vulvar cancer database for the period 1988 through 2000. The charts were reviewed, and the data were collected regarding patient demographics, previous Paget's treatment, symptoms, surgical margin status, associated malignancies, and time to recurrence. Results: Twenty-three women with extramammary Paget's disease of the vulva were treated by the Division of Gynecologic Oncology during the 12-year period. The average patient was postmenopausal and white and had symptoms for 21 months before the diagnosis was made. A pruritic lesion was the most common symptom. Treatment included wide local excision or vulvectomy, depending on the extent of disease. Six of the 23 patients displayed invasive disease and, consequently, underwent radical resection. There were 8 recurrences that were found, on average, 30 months after the surgical procedure. Two of the 8 patients had invasive disease at their primary operation, and 1 patient had underlying invasive disease at the time of recurrence. The average follow-up time was 39 months (median, 13.5 months; range, 1-216 months). Conclusion: Delay in diagnosis did not correlate with size or extent of disease. Margin status did not change the natural course of disease. Recurrence is relatively common, and long-term monitoring is recommended, with repeat excision of symptomatic lesions. (Am J Obstet Gynecol 2002;187:281-4.)

Section snippets

Material and methods

Our vulvar cancer database was reviewed, and women with extramammary Paget's disease of the vulva who were treated at the Division of Gynecologic Oncology during the period 1988 to 2000 were identified. The charts of these patients were reviewed, and data were collected regarding patient demographics, previous Paget's treatment, patient symptoms, surgical margin status, associated malignancies, and time to recurrence.

Surgical treatment included wide local excision for these lesions with a small

Results

Twenty-three women with extramammary Paget's disease of the vulva and perineum were treated during the 12-year period. Four of these patients had been treated previously for Paget's disease before our involvement. All the women were white. The average age of onset of symptoms was 68 years (median, 69 years; range, 46-84 years). The most common symptoms were a lesion (87%) and itching (78%). Other symptoms included a burning sensation (52%), dysuria (4%), and a watery discharge (4%). Symptoms

Comment

Paget's disease of the vulva remains a rare condition. The literature consists of only small case series. The demographics and disease characteristics of our patients are consistent with published reports.2, 3, 4 This is classically a postmenopausal disease, but it has been reported in a 35-year-old woman.5 Most of our patients experienced itching and burning and had a lesion.

There was a significant delay between the onset of symptoms and diagnosis. This delay did not correlate with the size or

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Reprint requests: Stephen Tebes, MD, 4 Columbia Dr, Ste 500, Harbourside Medical Tower, Tampa, FL 33606. E-mail: [email protected]

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