Application of reflectance confocal microscopy in extramammary Paget′s disease

Abstract

Extramammary Paget′s disease (EMPD) , a kind of cutaneous malignant tumor originating from apocrine glands, mostly occurs in the vulvar region in elderly men, and manifests as eczematoid lesions. EMPD usually progresses insidiously without specific clinical manifestations. Due to the mildness of symptoms at early stage, patients usually do not pay enough attention, and it is easily misdiagnosed. Most patients have a favorable prognosis, while long disease course, deep dermal infiltration and local lymph node metastasis indicate poor prognosis. The first-choice treatment of EMPD is extended surgical resection. However, the inaccuracy of macroscopic evaluation of tumor-free margins increases positive margin rates. Reflectance confocal microscopy (RCM) , as a kind of real time in vivo imaging technique, can be used for the diagnosis of EMPD and preoperative determination of tumor-free margins with reduced positive margin rates, recurrence rates and improved prognosis. Key words: Paget disease, extramammary; Diagnostic techniques and procedures; Therapeutic uses; Surgical procedures, operative; Reflectance confocal microscopy