Objective: Extramammary Paget’s disease (EMPD) is often misdiagnosed as chronic dermatitis or eczema of the scrotum because of its clinical manifestations, leading to delayed diagnosis and treatment. Reflectance confocal microscopy (RCM) and dermoscopy are widely used in clinical practice, enabling early diagnosis and treatment assessment of skin lesions, particularly skin tumors. This study aimed to summarize the RCM and dermoscopic features of EMPD and evaluate treatment outcomes. Methods: We conducted a retrospective analysis of 104 skin lesions from 34 patients diagnosed with EMPD, confirmed through histopathological examination. These patients were treated at our outpatient clinic between January 2022 and December 2023. The analysis focused on typical changes, such as blood vessel patterns and background color under dermoscopy, as well as cellular morphology under RCM. Count data were presented as constituent ratios. Results: Among the 34 patients, 28 were male and 6 were female, and 104 skin lesions were identified. The lesions were classified into three types: 36 red patches, 41 dark red erosive patches, and 27 brown pigmented patches. Dermoscopic examination of EMPD revealed characteristic features, including milky white globules (90.4%, 94/104), irregular shiny white streaks (91.3%, 95/104), dotted blood vessels (91.3%, 95/104), and glomerular-like vessels (88.5%, 92/104). RCM demonstrated epidermal structural disorganization (100%, 104/100), vacuolated cells in the epidermis (94.2%, 98/104), and Paget cells, either scattered or clustered (88.5%, 92/104). The red macular lesions predominantly contained isolated vacuolated cells in the epidermis, the dark red erosive lesions exhibited Paget cell nests in the basal layer, and the brown pigmented lesions contained numerous dendritic cells. These findings are crucial for clinical assessment, ensuring complete tumor removal, and guiding postoperative follow-up. Conclusion: This study identified characteristic dermoscopic and RCM features in patients with EMPD, providing a foundation for non-invasive auxiliary diagnosis. These features facilitate earlier diagnosis and treatment. Additionally, RCM characteristics of different lesion morphologies can help physicians more accurately assess surgical margins, leading to more precise surgical treatment options.
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