Toluidine blue for extramammary Paget’s disease in Mohs micrographic surgery

Roxana Mititelu,Claudia Flores-Echaiz,Manish Kanna

doi:10.25251/skin.5.1.16

Abstract

Introduction: We report an elderly gentleman with Extramammary Paget’s disease (EMPD) treated with Mohs micrographic surgery (MMS) using Toluidine blue staining intraoperatively as to detect the Paget’s cells. Case Presentation: An elderly man presented with an erythematous plaque on the left inguinal fold which showed in-situ EMPD on histopathological examination. Investigations for secondary EMPD were negative and the patient was treated with MMS. During MMS, the specimens from the patient were stained using Toluidine blue in order to detect the Paget cells and to determine the appropriate negative margin. At 4 years follow up the patient is free of recurrence. Conclusion: Toluidine blue is a fast, user-friendly dye that can be used intraoperatively during MMS as to detect Paget cells and thus to determine the appropriate negative margin.

Highlights

We report an elderly gentleman with Extramammary Paget’s disease (EMPD) treated with Mohs micrographic surgery (MMS) using Toluidine blue staining intraoperatively as to detect the Paget’s cells.Case Presentation: An elderly man presented with an erythematous plaque on the left inguinal fold which showed in-situ EMPD on histopathological examination
Extramammary Paget’s Disease (EMPD) is a rare skin malignancy that can pose a treatment challenge stemming from the difficulty of identifying tumor margins due to subclinical extension
We present a case of EMPD treated with MMS using Toluidine blue

Summary

Introduction

We report an elderly gentleman with Extramammary Paget’s disease (EMPD) treated with Mohs micrographic surgery (MMS) using Toluidine blue staining intraoperatively as to detect the Paget’s cells.Case Presentation: An elderly man presented with an erythematous plaque on the left inguinal fold which showed in-situ EMPD on histopathological examination. Conclusion: Toluidine blue is a fast, user-friendly dye that can be used intraoperatively during MMS as to detect Paget cells and to determine the appropriate negative margin. Extramammary Paget’s Disease (EMPD) is a rare skin malignancy that can pose a treatment challenge stemming from the difficulty of identifying tumor margins due to subclinical extension.

Results

Conclusion