Extramammary Paget's disease secondary prevention: Difference between revisions
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{{Extramammary Paget's disease}} | {{Extramammary Paget's disease}} | ||
{{CMG}}{{AE}}{{Simrat}} | |||
==Overview== | |||
==Secondary Prevention== | |||
*As some patients develop recurrences more than 15 years after initial treatment, follow up needs to be long term. Long-term follow up is necessary to exclude both local recurrence and the development of associated internal malignancies.<ref name="pmid7705692">{{cite journal| author=DiSaia PJ, Dorion GE, Cappuccini F, Carpenter PM| title=A report of two cases of recurrent Paget's disease of the vulva in a split-thickness graft and its possible pathogenesis-labeled "retrodissemination". | journal=Gynecol Oncol | year= 1995 | volume= 57 | issue= 1 | pages= 109-12 | pmid=7705692 | doi=10.1006/gyno.1995.1106 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7705692 }} </ref><ref name="pmid230392">{{cite journal| author=Oster MW, Magun A, Herter FP, Wolff M| title=Colorectal carcinoma 15 years after the diagnosis of perianal Paget disease. | journal=J Surg Oncol | year= 1979 | volume= 12 | issue= 4 | pages= 379 84 | pmid=230392 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=230392 }} </ref> | |||
*It is suggested that follow up for perianal extramammary Paget's disease (EMPD) should involve an annual complete physical examination, proctosigmoidoscopy and punch biopsy of any new lesion. Colonoscopy should be carried out at every two to three year intervals.<ref name="pmid9336114 [">{{cite journal| author=Sarmiento JM, Wolff BG, Burgart LJ, Frizelle FA, Ilstrup DM| title=Paget's disease of the perianal region--an aggressive disease? | journal=Dis Colon Rectum | year= 1997 | volume= 40 | issue= 10 | pages= 1187-94 | pmid=9336114 [ | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9336114 }} </ref> | |||
*Because of multifocality of lesions, local recurrences are common even when the margins of resection are negative. | |||
*Vulval EMPD may be similarly followed up with regular inspection of the vulva, the liberal use of punch biopsies to exclude invasive disease in any recurrent lesion and regular pelvic ultrasound scans and hysteroscopy.<ref name="pmid2850073">{{cite journal| author=Jensen SL, Sjølin KE, Shokouh-Amiri MH, Hagen K, Harling H| title=Paget's disease of the anal margin. | journal=Br J Surg | year= 1988 | volume= 75 | issue= 11 | pages= 1089-92 | pmid=2850073 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2850073 }} </ref> | |||
*Some physicians recommend lifelong follow-up after radical treatment of perianal disease, and the control examinations include a complete physical examination, proctosigmoidoscopy, double-contrast bowel enema, and biopsy of the perianal region once a year.<ref name="BeckFazio1987">{{cite journal|last1=Beck|first1=David E.|last2=Fazio|first2=Victor W.|title=Perianal Pagetʼs disease|journal=Diseases of the Colon & Rectum|volume=30|issue=4|year=1987|pages=263–266|issn=0012-3706|doi=10.1007/BF02556169}}</ref> | |||
In one series of perianal Paget's disease, the 5-year recurrence rate was 61%. Besa et al.11 observed a 36%–66% rate of positive margins after surgical excision alone in their series of 65 patients with empd of the perineal skin, and the actuarial local recurrence rate for patients treated with surgery was 40% within 5 years. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 14:09, 4 February 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]
Overview
Secondary Prevention
- As some patients develop recurrences more than 15 years after initial treatment, follow up needs to be long term. Long-term follow up is necessary to exclude both local recurrence and the development of associated internal malignancies.[1][2]
- It is suggested that follow up for perianal extramammary Paget's disease (EMPD) should involve an annual complete physical examination, proctosigmoidoscopy and punch biopsy of any new lesion. Colonoscopy should be carried out at every two to three year intervals.[3]
- Because of multifocality of lesions, local recurrences are common even when the margins of resection are negative.
- Vulval EMPD may be similarly followed up with regular inspection of the vulva, the liberal use of punch biopsies to exclude invasive disease in any recurrent lesion and regular pelvic ultrasound scans and hysteroscopy.[4]
- Some physicians recommend lifelong follow-up after radical treatment of perianal disease, and the control examinations include a complete physical examination, proctosigmoidoscopy, double-contrast bowel enema, and biopsy of the perianal region once a year.[5]
In one series of perianal Paget's disease, the 5-year recurrence rate was 61%. Besa et al.11 observed a 36%–66% rate of positive margins after surgical excision alone in their series of 65 patients with empd of the perineal skin, and the actuarial local recurrence rate for patients treated with surgery was 40% within 5 years.
References
- ↑ DiSaia PJ, Dorion GE, Cappuccini F, Carpenter PM (1995). "A report of two cases of recurrent Paget's disease of the vulva in a split-thickness graft and its possible pathogenesis-labeled "retrodissemination"". Gynecol Oncol. 57 (1): 109–12. doi:10.1006/gyno.1995.1106. PMID 7705692.
- ↑ Oster MW, Magun A, Herter FP, Wolff M (1979). "Colorectal carcinoma 15 years after the diagnosis of perianal Paget disease". J Surg Oncol. 12 (4): 379 84. PMID 230392.
- ↑ Sarmiento JM, Wolff BG, Burgart LJ, Frizelle FA, Ilstrup DM (1997). "Paget's disease of the perianal region--an aggressive disease?". Dis Colon Rectum. 40 (10): 1187–94. PMID [ 9336114 [ Check
|pmid=value (help). - ↑ Jensen SL, Sjølin KE, Shokouh-Amiri MH, Hagen K, Harling H (1988). "Paget's disease of the anal margin". Br J Surg. 75 (11): 1089–92. PMID 2850073.
- ↑ Beck, David E.; Fazio, Victor W. (1987). "Perianal Pagetʼs disease". Diseases of the Colon & Rectum. 30 (4): 263–266. doi:10.1007/BF02556169. ISSN 0012-3706.