Presenting as Intertrigo Kara Hoverson, MD, Nicole Cassler, MD and - PowerPoint PPT Presentation

Extramammary Paget's Disease Presenting as Intertrigo Kara Hoverson, MD, Nicole Cassler, MD and Nicholas Logemann Walter Reed National Military Medical Center Bethesda, MD

Disclosure of relevant relationships with industry No financial relationships exist with commercial interests.

History  80-year-old male with history significant for kidney transplant presented with a pruritic erythematous plaque in left inguinal crease.  Reported lesion had been present for 9 years  He had been treating the area intermittently with Neosporin for the past three months with no improvement.

History  Preliminary diagnosis of intertrigo was made.  Treated with topical cream containing nystatin, clindamycin, zinc and hydrocortisone BID with follow up in 4 weeks  The patient returned to clinic 9 months later with no resolution of his rash and a punch biopsy was performed

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Extramammary Pagets Disease • An erythematous slowly spreading plaque that is often mistaken as eczema, tinea cruris, or intertrigo by providers. • Usually affects sites with high density of apocrine glands such as the anogenital region and less commonly the axilla.

Prognosis • Approximately 25% of all cases have an underlying cutaneous adnexal carcinoma, mostly of apocrine type. • 10-15% of patients have an internal carcinoma involving the rectum, prostate, bladder, cervix or urethra. • The prognosis is generally good once diagnosed, except in cases with an underlying adnexal or visceral carcinoma, in which case the mortality rate may be 50% or higher.

Recommendations • Rule out an potential underlying malignancy. • Wide local excision is treatment of choice for EMPD. • Mohs micrographic surgery

Our patient • Screening colonoscopy, PSA serology, cystoscopy and renal ultrasound were all normal. • Diagnosed with primary extramammary Paget’s disease • The patient’s lesion was treated with Mohs micrographic surgery and he made an unremarkable recovery.

References  1.) Chanda J. Extramammary Paget's disease: prognosis and relationship to internal malignancy. J Am Acad Dermatol . 1985;13:1009.  2.) Perrotto, J., Abbott, J., Ceilley, R. & Ahmed, I. The Role of Immunohistochemistry in Discriminating Primary From Secondary Extramammary Paget Disease. American J Dermatopathol. 2010;32:137-143.  3.) Zhu Y,, Ye D., Yao X., Zhang S., Dai B., Zhang H., Shen Y. & Mao H. Clinicopathological characteristics, management and outcome of metastatic penoscrotal extramammary Paget’s disease. B J Dermatol. 2009;161:577-582.  4.) Weedon D. Weedon’s Skin Pathology . 3 rd ed. London: Churchill Livingstone Elsevier, 2010.  5.) Glasgow, B., Wen, D., Al-Jitawi, S. & Cochran, A. (1987). Antibody to S-100 protein aids the separation of pagetoid melanoma from mammary and extramammary Paget’s disease. J Cutan Pathol . 1987;14:223-226