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Mohs surgery effectively treated extramammary Paget’s disease

Mohs micrographic surgery was effective in treating extramammary Paget’s disease, with a lower recurrence rate when compared with wide local excision, according to recent study results.

Using individual patient data meta-analysis, researchers in South Korea reviewed all available clinical studies and case reports with five or more patients describing the use of Mohs micrographic surgery (MMS) for treating extramammary Paget’s disease (EMPD), an uncommon intraepithelial adenocarcinoma that derives from pluripotent keratinocyte stem cells within the epidermis. Medline, Embase and Cochrane Central Register of Controlled Trials in the Cochrane Library from inception to July 17, 2012 were used in search.

Eight studies (two case series and six retrospective reviews) were identified and included. Wide local excision (WLE) and MMS were used in three of the retrospective reviews, while the other five studies reported results from MMS only.

The studies (seven conducted in the United States) included 81 patients (median age, 68 years; 62.3% men) with 90 cases of MMS. After MMS, EMPD had an overall recurrence rate of 12.2%, and the estimated tumor-free rate at 5 years was 83.6% (95% CI, 74%-94.5%). In subgroup analysis at 5 years after MMS, tumor-free rates for recurrent and primary EMPD were 71.1% (95% CI, 48.8%-100%) and 80.9% (95% CI, 68.4%-95.7%), respectively.

EMPD patients treated with MMS had lower recurrence rates than those undergoing wide local excision (OR=0.20; 95% CI, 0.05-0.81) with no heterogeneity (I2=0%).

Lack of controlled trials, having just three studies for comparison and the small case number of each study were limitations, the researchers wrote.

“Our meta-analysis … presents evidence that the efficacy of MMS in the treatment of EMPD may be superior to WLE,” the researchers concluded. “However, large randomized controlled trials that compare treatment modalities for EMPD with long-term follow-up are still needed to make a recommendation for the treatment of EMPD.”