31840 Local recurrence rates of extramammary Paget disease are lower following Mohs micrographic surgery compared with wide local excision: A systematic review and meta-analysis

Abstract

Background: Extramammary Paget disease (EMPD) is a rare, slow growing neoplasm that presents most commonly in the anogenital region of older adults. Objective: To analyze the difference in local recurrence rates of EMPD in patients treated with wide local excision (WLE) versus Mohs micrographic surgery (MMS). Methods: A systematic review of the literature and meta-analysis were performed. Inclusion criteria was adults greater than 18 years of age with a diagnosis of EMPD who have undergone surgical intervention and had follow-up data. Studies were independently reviewed by 2 coinvestigators with discrepancies resolved by the principal investigator. Results: Twenty-seven studies met the inclusion criteria. Patients had a 2.67 times higher chance of local recurrence after WLE compared with MMS (95% CI 1.47-4.85; P = .001). Meta-analysis of single arm studies revealed a 7.3% local recurrence rate after MMS (95% CI 0.039-0.107; P < .001) versus a 26.3% recurrence rate after WLE (95% CI 0.149-0.376; P < .001). After excluding recurrent tumors, the odds ratio for recurrence in WLE vs. MMS was 2.3 (95% CI 0.285-18.43, P = .435). Limitations: Our study was limited by the lack of available prospective randomized control trials. Conclusion: There is a clinically and statistically increased risk of local recurrence of EMPD after WLE compared with MMS.