EXTRAMAMMARY PAGET'S DISEASE WITH METHOTREXATE THERAPY: A CASE REPORT
Keywords:
Extramammary Paget's disease, methotrexate, topical therapy, case report, anogenital malignancyAbstract
Introduction: Extramammary Paget's Disease (EMPD) is an uncommon intraepidermal adenocarcinoma that develops in regions containing apocrine glands, including the scrotum, inguinal folds, and perineum. It is most frequently observed in older adults and is often initially mistaken for benign conditions such as dermatitis or fungal infections due to its vague clinical appearance.
Case Report: A 67-year-old man presented with a one-year history of erythematous, pruritic, and painful lesions located in the right groin and scrotal area. Physical examination revealed an erythematous patch with hyperpigmented macules, accompanied by erosion, scaling, and a plaque-like kissing lesion. Histopathological analysis confirmed the presence of characteristic Paget cells within the epidermis, leading to a definitive diagnosis of EMPD. The patient received therapy with topical methotrexate combined with topical gentamicin.
Discussion: Diagnosing EMPD is challenging because its clinical features mimic those of common inflammatory skin disorders. Histopathology remains the diagnostic gold standard. Although surgical excision is the conventional treatment, topical methotrexate represents a promising non-invasive alternative, especially for limited disease or when surgery is not feasible. In the present case, marked clinical improvement was noted after four weeks of treatment, including reduced erythema and erosion, along with complete resolution of pruritus and pain.
Conclusion: The combination of topical methotrexate and gentamicin produced favorable clinical results in this elderly patient with EMPD. This case supports the potential role of topical methotrexate as a safe, cost-effective, and well-tolerated therapeutic option for selected individuals with EMPD.
References
Kang S, Amagai M, Bruckner AL, Enk AH, Margolis DJ, McMichael AJ, et al. Fitzpatrick's Dermatology. 9th ed. Kang S, Amagai M, Bruckner AL, Enk AH, Margolis DJ, McMichael AJ, et al., editors. Vol. 11, Analytical Biochemistry. United State: McGraw-Hill Education; 2019.
Non melanoma skin cancer (NMSC): Extramammary Paget's disease. Rom J Mil Med. 2020;123(3):184–9.
Ishizuki S, Nakamura Y. Extramammary paget's disease: Diagnosis, pathogenesis, and treatment with focus on recent developments. Curr Oncol. 2021;28(4):2969–86.
Nicaise EH, McNamara M, Schmeusser BN, Palmateer G, Patil D, Petros J, et al. Incidence and survival of Extramammary Paget's Disease from the Surveillance, Epidemiology, and End Results (SEER) database. Surg Oncol Insight [Internet]. 2024;1(3):100064. Available from: https://doi.org/10.1016/j.soi.2024.100064
Shah RR, Shah K, Wilson BN, Tchack M, Busam KJ, Moy A, et al. Extramammary Paget disease. Part I. epidemiology, pathogenesis, clinical features, and diagnosis. J Am Acad Dermatol [Internet]. 2024;91(3):409–18. Available from: https://doi.org/10.1016/j.jaad.2023.07.1051
van der Linden M, Meeuwis KAP, Bulten J, Bosse T, van Poelgeest MIE, de Hullu JA. Paget disease of the vulva. Crit Rev Oncol Hematol [Internet]. 2016;101:60–74. Available from: http://dx.doi.org/10.1016/j.critrevonc.2016.03.008
Wolff K, Johnson RA, Saavedra AP. Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology. 7th ed. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. United State: McGraw-Hill Education; 2013. 1–955 p.
Claire K St., Hoover A, Ashack K, Khachemoune A. Extramammary Paget disease. Treat Ski Dis Compr Ther Strateg. 2019;25(4):1.
Mocanu M, Procopciuc D, Gheucă-Solovăstru DF, Popescu IA, Olinici DT, Pătrașcu AI, et al. An Overview of Methotrexate Indications in Skin Diseases. Medicina (B Aires) [Internet]. 2024;60(7):1–13. Available from: https://doi.org/10.3390/medicina60071024
Lebas E, Chapelier C, Quatresooz P, Seidel L, Nikkels AF. Exploratory Assessment of Oxygen Flow–Assisted Cutaneous Administration of Methotrexate for Superficial Basal Cell Carcinoma, Mycosis Fungoides, and Extramammary Paget Disease. J Invest Dermatol [Internet]. 2020;140(3):583–92. Available from: https://doi.org/10.1016/j.jid.2019.08.443
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