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Extramammary Paget’s Disease: Current Treatment Paradigms and Future Therapeutic Directions

Year: 2026

Type: article

Abstract: Extramammary Paget’s disease (EMPD) is a rare cutaneous adenocarcinoma arising in apocrine gland-bearing areas, such as the perineal, genital, and axillary regions, characterized by pruritic, erythematous plaques that can be misdiagnosed as dermatitis or fungal infections. Standard treatment involves surgical excision with wide margins; however, EMPD frequently occurs in anatomically sensitive areas where surgery may lead to severe functional impairments, including incontinence, sexual dysfunction, or substantial aesthetic disfigurement. Many of these concerns, coupled with potential postoperative morbidity, often prompt patients to avoid surgery altogether or seek less invasive alternatives. As a result, non-surgical topical treatments are gaining interest as viable alternatives, particularly for patients who are either unsuitable for surgery or wish to avoid its associated complications. This review investigates the efficacy of topical therapies for EMPD, including imiquimod, an immune response modifier shown to enhance local cell-mediated immunity against malignant cells; 5-fluorouracil, a topical chemotherapeutic agent that disrupts DNA synthesis in rapidly proliferating tumor cells; and ingenol mebutate, which induces rapid apoptosis in epidermal neoplasms. Additionally, long-term outcomes, including recurrence rates, cosmetic results, and potential side effects, are evaluated to assess their suitability as stand alone treatments or adjuncts in cases where surgical excision is contraindicated. Specific patient populations, such as elderly individuals, those with significant comorbidities, or patients with high surgical risk, are identified as potential candidates for these non-surgical approaches. This comprehensive analysis provides critical insights into expanding therapeutic options for EMPD, offering a nuanced understanding of when non-surgical management may be preferable over traditional surgical interventions

Source: ARC Journal of Dermatology

DOI: 10.20431/2456-0022.0902003