Extramammary Paget's disease of the vulva with dermal invasion and vulval intra-epithelial neoplasia.

Vulval biopsies from a 66-year-old lady complaining of pruritus showed intraepithelial Paget's disease. On simple vulvectomy, extramammary Paget's disease was found to be associated with vulval intra-epithelial neoplasia (VIN III) and superficial dermal invasive adenocarcinoma. Bilateral inguinal lymphadenectomy later revealed metastatic spread of the tumour. We believe this is a unique combination and discuss the possible origins in relation to this lady's past medical history of breast carcinoma 20 years and spinal metastases 17 years before.