Journal List > Korean J Obstet Gynecol > v.54(8) > 1088320

Cho, Roh, and Lee: PAGET'S DISEASE OF THE VULVA TREATED BY WIDE EXCISION AND RECONSTRUCTION WITH SKIN GRAFTS AND FLAPS: REPORTS OF THREE CASES

Abstract

Extramammary Paget's disease is a rare, slow-growing, non-invasive intraepithelial adenocarcinoma that occurs mainly in the elderly outside of the mammary gland. Paget's disease of the vulva accounts for less than 1% of all vulvar malignancies. The standard treatment is wide local excision of the gross lesion. To prevent a relapse, wide excision with adequate margins is necessary not to leave pathologic lesions around margins of excision. However, since the excised area is too wide to cover all the exposed surface with a simple closure only, skin grafts and flaps can be very useful. We report successful treatment of three cases of extramammary Paget's disease of the vulva using frozen section analyses of the margins during operation in order to attain Paget's cells free margins and skin grafts and flaps to cover an extensive defects.

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Fig. 1.
Preoperative finding: eczematoid lesion on left labium major (A). Postoperative finding: wide local excision and coverage by split-thickness skin graft (B).
kjog-54-474f1.tif
Fig. 2.
Microscopic features of vulvar Paget's disease. Large pale tumor cells dispersed singly or in clusters of solid nests and glandular spaces within the epidermis (H&E, ×100) (A). Tumor cells have abundant pale cytoplasm with large nucleus and prominent nucleolus at high-power view (H&E, ×400) (B).
kjog-54-474f2.tif
Fig. 3.
Preoperative finding: reddish eczematoid lesion on both labium major (A). Postoperative finding: wide local excision and coverage by bilateral perineal perforator island flap (B).
kjog-54-474f3.tif
Fig. 4.
Preoperative finding: eczematoid lesion on both labium major (A). Postoperative finding: wide local excision and coverage by bilateral medial thigh perforator based V-Y advancement flap (B).
kjog-54-474f4.tif
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