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

Dong-Hyu Cho; Si-Gyun Roh; Jeong-Heon Lee

doi:10.5468/KJOG.2011.54.8.474

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

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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

Case Report

Korean J Obstet Gynecol 2011;54(8):474-479.

Published online: 21 January 2011

DOI: https://doi.org/10.5468/KJOG.2011.54.8.474

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

Dong-Hyu Cho, MD¹, Si-Gyun Roh², Jeong-Heon Lee, MD¹

¹Department of Obstetrics and Gynecology, Chonbuk National University Medical School, Jeonju, Korea

²Department of Plastic and Reconstructive Surgery, Chonbuk National University Medical School, Jeonju, Korea

Corresponding author: Jeong-Heon Lee, MD Department of Obstetrics and Gynecology, Chonbuk National University Medical School, 634-18 Geumam-dong, Deokjin-gu, Jeonju 561-712, Korea Tel: +82-63-250-1360 Fax: +82-63-254-4833 E-mail: jh.lee@jbnu.ac.kr

Received 4 April 2011 Revised 17 May 2011 Accepted 16 June 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Paget's disease, Vulva, Skin grafts and flaps

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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).

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).

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).

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).

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