Extramammary Paget's disease physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Common physical examination findings of extramammary Paget's disease include well demarcated, erythematous or leucoplakic plaques present on the skin, characteristic ‘cake-icing’ appearance of vulval extramammary Paget's disease, consisting of erythematous changes associated with white islands and bridges of hyperkeratotic epithelium, and lymphadenopathy.<ref name="pmid8393362">{{cite journal| author=Heymann WR| title=Extramammary Paget's disease. | journal=Clin Dermatol | year= 1993 | volume= 11 | issue= 1 | pages= 83-7 | pmid=8393362 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8393362 }} </ref><ref>Silverberg, Steven G., and Ronald A. DeLellis. Silverberg's principles and practice of surgical pathology and cytopathology. Edinburgh: Churchill Livingstone/Elsevier, 2006. Print.</ref> | Common physical examination findings of extramammary Paget's disease include well demarcated, [[erythematous]] or [[leucoplakic]] plaques present on the skin, characteristic ‘cake-icing’ appearance of vulval extramammary Paget's disease, consisting of erythematous changes associated with white islands and bridges of hyperkeratotic epithelium, and [[lymphadenopathy]].<ref name="pmid8393362">{{cite journal| author=Heymann WR| title=Extramammary Paget's disease. | journal=Clin Dermatol | year= 1993 | volume= 11 | issue= 1 | pages= 83-7 | pmid=8393362 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8393362 }} </ref><ref>Silverberg, Steven G., and Ronald A. DeLellis. Silverberg's principles and practice of surgical pathology and cytopathology. Edinburgh: Churchill Livingstone/Elsevier, 2006. Print.</ref> | ||
==Physical Examination== | ==Physical Examination== | ||
Early skin changes may be subtle and vary according to location. Only slight erythema, crusting, and increased maceration may be noted, initially.However, pruritus commonly leads to prominent lichenification and excoriations. The most commonly affected site is the vulva, followed by perineal, perianal, scrotal and penile skin. Less commonly, the buttocks, axilla, thighs, eyelids and external auditory canal may be affected.<ref name="pmid8393362">{{cite journal| author=Heymann WR| title=Extramammary Paget's disease. | journal=Clin Dermatol | year= 1993 | volume= 11 | issue= 1 | pages= 83-7 | pmid=8393362 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8393362 }} </ref><ref>Silverberg, Steven G., and Ronald A. DeLellis. Silverberg's principles and practice of surgical pathology and cytopathology. Edinburgh: Churchill Livingstone/Elsevier, 2006. Print.</ref> | Early skin changes may be subtle and vary according to location. Only slight erythema, crusting, and increased maceration may be noted, initially. However, [[pruritus]] commonly leads to prominent [[lichenification]] and excoriations. The most commonly affected site is the [[vulva]], followed by perineal, [[perianal]], scrotal and penile skin. Less commonly, the buttocks, axilla, thighs, eyelids and external auditory canal may be affected.<ref name="pmid8393362">{{cite journal| author=Heymann WR| title=Extramammary Paget's disease. | journal=Clin Dermatol | year= 1993 | volume= 11 | issue= 1 | pages= 83-7 | pmid=8393362 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8393362 }} </ref><ref>Silverberg, Steven G., and Ronald A. DeLellis. Silverberg's principles and practice of surgical pathology and cytopathology. Edinburgh: Churchill Livingstone/Elsevier, 2006. Print.</ref> | ||
A detailed review of systems and physical examination should be performed in all patients with extramammary Paget's disease. The examination should include the following: | A detailed review of systems and physical examination should be performed in all patients with extramammary Paget's disease. The examination should include the following: | ||
*Full skin examination | *Full skin examination | ||
| Line 11: | Line 11: | ||
*Rectal examination | *Rectal examination | ||
===Skin=== | ===Skin=== | ||
*Well-demarcated, erythematous or leucoplakic plaques are present. | *Well-demarcated, [[erythematous]] or leucoplakic plaques are present. | ||
*May appear as chronic intertrigo or presumed tinea cruris | *May appear as chronic intertrigo or presumed tinea cruris | ||
===Genitourinary=== | ===Genitourinary=== | ||
| Line 17: | Line 17: | ||
*Whitish discharge may be present | *Whitish discharge may be present | ||
*Characteristic ‘cake-icing’ appearance of vulval extramammary Paget's disease, consisting of erythematous changes associated with white islands and bridges of hyperkeratotic epithelium | *Characteristic ‘cake-icing’ appearance of vulval extramammary Paget's disease, consisting of erythematous changes associated with white islands and bridges of hyperkeratotic epithelium | ||
*Inguinal lymphadenopathy may present | *[[Inguinal lymphadenopathy]] may present | ||
*A palpable mass with or without lymphadenopathy raises suspicion of invasive disease | *A palpable mass with or without lymphadenopathy raises suspicion of invasive disease | ||
===Neck=== | ===Neck=== | ||
*Lymphadenopathy may be present | *[[Lymphadenopathy]] may be present | ||
<gallery> | <gallery> | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]Simrat Sarai, M.D. [3]
Overview
Common physical examination findings of extramammary Paget's disease include well demarcated, erythematous or leucoplakic plaques present on the skin, characteristic ‘cake-icing’ appearance of vulval extramammary Paget's disease, consisting of erythematous changes associated with white islands and bridges of hyperkeratotic epithelium, and lymphadenopathy.[1][2]
Physical Examination
Early skin changes may be subtle and vary according to location. Only slight erythema, crusting, and increased maceration may be noted, initially. However, pruritus commonly leads to prominent lichenification and excoriations. The most commonly affected site is the vulva, followed by perineal, perianal, scrotal and penile skin. Less commonly, the buttocks, axilla, thighs, eyelids and external auditory canal may be affected.[1][3] A detailed review of systems and physical examination should be performed in all patients with extramammary Paget's disease. The examination should include the following:
- Full skin examination
- Palpation of all lymph nodes
- Rectal examination
Skin
- Well-demarcated, erythematous or leucoplakic plaques are present.
- May appear as chronic intertrigo or presumed tinea cruris
Genitourinary
- The affected skin may appear eczematous, papillomatous, lichenified, leucokeratotic, or ulcerated
- Whitish discharge may be present
- Characteristic ‘cake-icing’ appearance of vulval extramammary Paget's disease, consisting of erythematous changes associated with white islands and bridges of hyperkeratotic epithelium
- Inguinal lymphadenopathy may present
- A palpable mass with or without lymphadenopathy raises suspicion of invasive disease
Neck
- Lymphadenopathy may be present
-
![Extramammary paget's disease. With permission from Dermatology Atlas.[4]](/images/c/cb/Extramammary_paget%27s_disease01.jpg)
Extramammary paget's disease. With permission from Dermatology Atlas.[4]
![Extramammary paget's disease. With permission from Dermatology Atlas.[4]](/index.php/File:Extramammary_paget%27s_disease01.jpg)
References
- ↑ 1.0 1.1 Heymann WR (1993). "Extramammary Paget's disease". Clin Dermatol. 11 (1): 83–7. PMID 8393362.
- ↑ Silverberg, Steven G., and Ronald A. DeLellis. Silverberg's principles and practice of surgical pathology and cytopathology. Edinburgh: Churchill Livingstone/Elsevier, 2006. Print.
- ↑ Silverberg, Steven G., and Ronald A. DeLellis. Silverberg's principles and practice of surgical pathology and cytopathology. Edinburgh: Churchill Livingstone/Elsevier, 2006. Print.
- ↑ "Dermatology Atlas".