P79 Successful treatment of extramammary Paget's disease with topical imiquimod

Abstract

A 69-year-old woman suffered from anogenital pruritus for five years. Her gynaecolocist prescribed topical estrogen assuming a hormonal dysfunction. Due to persistence of symptoms, biopsies of the respective sites in the introitus vaginae were taken. Histological examination revealed extramammary Paget/s disease. Vulvectomy was performed. Results showed extramammary Paget/s disease still present in all resection margins, reaching the clitoris and the perianal area. The patient was referred to our outpatient clinic. Because of the extensive local findings and the risk of loss of function and mutilation, decision against radical surgery was made and local therapy with imiquimod 5% cream was started for three months. After resolution of the induced inflammatory reaction, three biopsies were performed to control success of therapy. Only one of the samples still showed extramammary Paget/s disease, primary excision of this small area was performed. After one year of follow up, the patient is well without signs of recurrence. Topical imiquimod may well be a good alternative to radical mutilating excision of extramammary Paget/s disease. Close follow up and histological controls are mandatory.