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P3.192 Conservative Treatment of Penile Extramammary Paget Disease in HIV Positive Patient - Imiquimod Cream Vs. Photodynamic Therapy
  1. Z Kruzicova,
  2. D Vanousova,
  3. N Vojackova,
  4. J Hercogova
  1. Dermatovenerologic Dpt.; 2nd Faculty of Medicine, Charles University, Prague, Czech Republic 2nd Faculty of Medicine, Charles University, Prague, Czech Republic

Abstract

Background The penis is an uncommon site for the presentation of extramammary Paget disease (EMPD). EMPD usually occurs in individuals between the ages of 50–80 years and is more common in women. European age standardised Incidence of EMPD within Europe is 0.6 per 1000,000 person years. Radical resection of diseased skin is the preferred therapy. Several non-surgical modalities have been used to treat EMPD, which include radiotherapy, topical imiquimod, topical 5-fluorouracil, topical bleomycin, photodynamic therapy, CO2 laser ablation, and topical retinoids. Systemic chemotherapy also has been used to treat advanced EMPD.

We describe a case of EMPD that was discovered in our patient.

Results The patient initially underwent a biopsy from the lesion on the glans penis with the result EMPD. Based on CT examination the tumour (size 3 × 2cm) was localised on the glans penis, with no signs of overgrowth from the urogenital tract. The urologists recommended wide local excision of the tumour or glansectomia as the last treatment possibility due to the potential functional disability of the genital.

We started the conservative therapy with imiquimod cream with initial good response. Due to the lack of effect of the imiquimod after 3 weeks the treatment was changed to the photodynamic therapy (PDT). After three cycles of PDT at intervals of two months seems the results to be satisfactory based on the gradual regression of the tumour.

Conclusion The photodynamic therapy seems to be an effective therapy for the conservative treatment of EMPD in patients in whom is the surgical treatment contraindicated for some reason.

  • Extramammary Paget Disease
  • Imiquimod
  • Photodynamic therapy

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