Jung Min Bae1, Yoon Young Choi2, Heesu Kim1, Byung Ho Oh1, Mi Ryung Roh3, KyoungAe Nam4, Kee Yang Chung5. 1. Department of Dermatology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea. 2. Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. 3. Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea; Department of Dermatology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. 4. Department of Dermatology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. 5. Department of Dermatology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea; Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea. Electronic address: kychung@yuhs.ac.
Abstract
BACKGROUND: Extramammary Paget disease (EMPD) is a rare intraepithelial neoplasm of the skin characterized by ill-defined margins and high recurrence rates after wide local excision. Although Mohs micrographic surgery (MMS) has been proposed to decrease the rate of local recurrence, the efficacy of MMS for this condition has not yet been established. OBJECTIVE: We sought to assess the efficacy of MMS for the treatment of EMPD. METHODS: A comprehensive systematic review and individual patient data meta-analysis was performed including all available clinical studies and case reports with 5 or more subjects describing the use of MMS for EMPD. RESULTS: Eight studies were identified and included in the current review: 3 retrospective studies and 5 case series. In all, 81 patients with 90 cases of MMS were included from these 8 studies. The overall recurrence rate for EMPD after MMS was 12.2% correlating with an estimated 5-year tumor-free rate of 83.6% by using Kaplan-Meier curve analysis. The treatment of EMPD with MMS resulted in significantly lower recurrence rates than wide local excision in this meta-analysis of 3 observational studies with comparators (odds ratio 0.20; 95% confidence interval 0.05-0.81). LIMITATIONS: Limitations include lack of controlled trials, small sample sizes in the included studies, and publication bias. CONCLUSION: The current evidence supports the efficacy of MMS in the treatment of EMPD. Further controlled clinical trials are needed.
BACKGROUND: Extramammary Paget disease (EMPD) is a rare intraepithelial neoplasm of the skin characterized by ill-defined margins and high recurrence rates after wide local excision. Although Mohs micrographic surgery (MMS) has been proposed to decrease the rate of local recurrence, the efficacy of MMS for this condition has not yet been established. OBJECTIVE: We sought to assess the efficacy of MMS for the treatment of EMPD. METHODS: A comprehensive systematic review and individual patient data meta-analysis was performed including all available clinical studies and case reports with 5 or more subjects describing the use of MMS for EMPD. RESULTS: Eight studies were identified and included in the current review: 3 retrospective studies and 5 case series. In all, 81 patients with 90 cases of MMS were included from these 8 studies. The overall recurrence rate for EMPD after MMS was 12.2% correlating with an estimated 5-year tumor-free rate of 83.6% by using Kaplan-Meier curve analysis. The treatment of EMPD with MMS resulted in significantly lower recurrence rates than wide local excision in this meta-analysis of 3 observational studies with comparators (odds ratio 0.20; 95% confidence interval 0.05-0.81). LIMITATIONS: Limitations include lack of controlled trials, small sample sizes in the included studies, and publication bias. CONCLUSION: The current evidence supports the efficacy of MMS in the treatment of EMPD. Further controlled clinical trials are needed.
Authors: Michelle van der Linden; Kim Meeuwis; Colette van Hees; Eleonora van Dorst; Johan Bulten; Tjalling Bosse; Joanna IntHout; Dorry Boll; Brigitte Slangen; Manon van Seters; Marc van Beurden; Mariëtte van Poelgeest; Joanne de Hullu Journal: JMIR Res Protoc Date: 2017-09-06