Presenting as Intertrigo Kara Hoverson, MD, Nicole Cassler, MD and - - PowerPoint PPT Presentation

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Presenting as Intertrigo Kara Hoverson, MD, Nicole Cassler, MD and - - PowerPoint PPT Presentation

Sep 22, 2022 36 likes •182 views

Extramammary Paget's Disease Presenting as Intertrigo Kara Hoverson, MD, Nicole Cassler, MD and Nicholas Logemann Walter Reed National Military Medical Center Bethesda, MD Disclosure of relevant relationships with industry No financial

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Extramammary Paget's Disease Presenting as Intertrigo

Kara Hoverson, MD, Nicole Cassler, MD and Nicholas Logemann Walter Reed National Military Medical Center Bethesda, MD

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No financial relationships exist with commercial interests.

Disclosure of relevant relationships with industry

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 80-year-old male with history significant for kidney transplant presented with a pruritic erythematous plaque in left inguinal crease.  Reported lesion had been present for 9 years  He had been treating the area intermittently with Neosporin for the past three months with no improvement.

History

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 Preliminary diagnosis of intertrigo was made.  Treated with topical cream containing nystatin, clindamycin, zinc and hydrocortisone BID with follow up in 4 weeks  The patient returned to clinic 9 months later with no resolution of his rash and a punch biopsy was performed

History

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H&E 200X

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CK7

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CK20

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  • An erythematous slowly spreading plaque that is
  • ften mistaken as eczema, tinea cruris, or intertrigo

by providers.

  • Usually affects sites with high density of apocrine

glands such as the anogenital region and less commonly the axilla.

Extramammary Pagets Disease

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  • Approximately 25% of all cases have an underlying

cutaneous adnexal carcinoma, mostly of apocrine type.

  • 10-15% of patients have an internal carcinoma involving

the rectum, prostate, bladder, cervix or urethra.

  • The prognosis is generally good once diagnosed, except

in cases with an underlying adnexal or visceral carcinoma, in which case the mortality rate may be 50%

  • r higher.

Prognosis

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  • Rule out an potential underlying malignancy.
  • Wide local excision is treatment of choice for EMPD.
  • Mohs micrographic surgery

Recommendations

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  • Screening colonoscopy, PSA serology, cystoscopy

and renal ultrasound were all normal.

  • Diagnosed with primary extramammary Paget’s

disease

  • The patient’s lesion was treated with Mohs

micrographic surgery and he made an unremarkable recovery.

Our patient

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 1.) Chanda J. Extramammary Paget's disease: prognosis and relationship to internal

  • malignancy. J Am Acad Dermatol. 1985;13:1009.

 2.) Perrotto, J., Abbott, J., Ceilley, R. & Ahmed, I. The Role of Immunohistochemistry in Discriminating Primary From Secondary Extramammary Paget Disease. American J

  • Dermatopathol. 2010;32:137-143.

 3.) Zhu Y,, Ye D., Yao X., Zhang S., Dai B., Zhang H., Shen Y. & Mao H. Clinicopathological characteristics, management and outcome of metastatic penoscrotal extramammary Paget’s disease. B J Dermatol. 2009;161:577-582.  4.) Weedon D. Weedon’s Skin Pathology. 3rd ed. London: Churchill Livingstone Elsevier, 2010.  5.) Glasgow, B., Wen, D., Al-Jitawi, S. & Cochran, A. (1987). Antibody to S-100 protein aids the separation of pagetoid melanoma from mammary and extramammary Paget’s

  • disease. J Cutan Pathol. 1987;14:223-226

References