Ali A Damavandy1, Vitaly Terushkin2, John A Zitelli3,4, David G Brodland3,4, Christopher J Miller5, Jeremy R Etzkorn6, Thuzar M Shin6, Mark A Cappel7, Mario Mitkov7, Ali Hendi8,9. 1. District Dermatology PLLC, McLean, Virginia. 2. Volunteer Faculty, Department of Dermatology, Weill Cornell Medical Center, New York, New York. 3. Zitelli and Brodland PC, Pittsburgh, Pennsylvania. 4. Departments of Dermatology, Otolaryngology, and Plastic Surgery, the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 5. Division of Dermatologic Surgery, Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. 6. Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. 7. Department of Dermatology, Mayo Clinic, Jacksonville, Florida. 8. Ali Hendi MD PC, Chevy Chase, Maryland. 9. Department of Dermatology, Georgetown University Hospital, Washington, District of Columbia.
Abstract
BACKGROUND: Extramammary Paget's disease (EMPD) is a rare intraepithelial malignancy with high recurrence rates following standard surgical treatments, ranging from 22% to 60% in large retrospective reviews. OBJECTIVE: To evaluate the local recurrence rate of Mohs micrographic surgery (MMS) supplemented with intraoperative immunohistochemistry for cytokeratin-7 (MMS + CK-7) for primary and recurrent EMPD. MATERIALS AND METHODS: Retrospective, multi-center, cross-sectional study of patients treated using MMS + CK-7. Demographic, clinicopathologic, treatment, and follow-up data were obtained by chart review. RESULTS: The observed local recurrence rate for MMS + CK-7 is 3.3% (2/61 tumors) with a mean follow-up of 43.5 months (1-120 months). Local recurrence occurred in 2.3% (1/43) of primary tumors and 5.6% (1/18) of recurrent tumors. Kaplan-Meier 5-year tumor-free rates are 94.6% overall, 97.1% for primary tumors, and 80.0% for recurrent tumors. The Kaplan-Meier 5-year tumor-free rates for all EMPD tumors treated with MMS + CK-7 versus a historical cohort of MMS alone are 94.6% versus 72.0% (p = .012). CONCLUSION: MMS + CK-7 is an effective treatment for EMPD, demonstrating improved outcomes compared with historical controls.
BACKGROUND: Extramammary Paget's disease (EMPD) is a rare intraepithelial malignancy with high recurrence rates following standard surgical treatments, ranging from 22% to 60% in large retrospective reviews. OBJECTIVE: To evaluate the local recurrence rate of Mohs micrographic surgery (MMS) supplemented with intraoperative immunohistochemistry for cytokeratin-7 (MMS + CK-7) for primary and recurrent EMPD. MATERIALS AND METHODS: Retrospective, multi-center, cross-sectional study of patients treated using MMS + CK-7. Demographic, clinicopathologic, treatment, and follow-up data were obtained by chart review. RESULTS: The observed local recurrence rate for MMS + CK-7 is 3.3% (2/61 tumors) with a mean follow-up of 43.5 months (1-120 months). Local recurrence occurred in 2.3% (1/43) of primary tumors and 5.6% (1/18) of recurrent tumors. Kaplan-Meier 5-year tumor-free rates are 94.6% overall, 97.1% for primary tumors, and 80.0% for recurrent tumors. The Kaplan-Meier 5-year tumor-free rates for all EMPD tumors treated with MMS + CK-7 versus a historical cohort of MMS alone are 94.6% versus 72.0% (p = .012). CONCLUSION: MMS + CK-7 is an effective treatment for EMPD, demonstrating improved outcomes compared with historical controls.
Authors: Gabriel E Molina; Saami Khalifian; Jamie L Mull; Lu Chen; Ilana S Rosman; Beverly E Faulkner-Jones; Kenneth H Ngo; Shadmehr Demehri; Lynn A Cornelius; Peggy A Wu Journal: JAMA Dermatol Date: 2019-05-01 Impact factor: 10.282