A case series of vulvar Paget’s disease in women from two different clinical settings (2019)

Type of publication:
Conference abstract

Author(s):
*Papoutsis D.; Borella F.

Citation:
Journal of Lower Genital Tract Disease; Oct 2019; vol. 23 (no. 4S):S37-S81

Abstract:
Objectives: Vulvar Paget’s disease (VPD) is an extremely rare neoplasm that accounts for less than 1% of vulvar pre-malignancies/malignancies. We present four cases of women diagnosed with VPD.
Method(s): The databases of two tertiary hospitals (one in the United Kingdom and one in Italy) were searched for cases of VPD and information was retrieved. We present the clinical manifestation and management of four cases of VPD.
Result(s): The first case involved a 77-year old woman with vulvar soreness for more than two months unresponsive to topical antifungals. On examination a 2 cm velvety-red colored left labial lesion was noted. Due to the small-sized lesion she was offered vulvar surgery and at follow-up she has no signs of recurrence. The second case involved a 62-year old woman with a history of stage T1b breast cancer. She presented with a 5×3 cm left labial lesion that extended to the perianal areas. Due to the large lesion size she was offered topical
imiquimod and at follow-up she has no recurrence. The third case involved a 62-year old woman presenting with vulvar itching for about 18 months. She had a previous history of colon cancer that was surgically treated. She underwent wide local excision of the vulvar lesion that measured 5 cm . Due to VPD recurrence after 4 months she was further treated with imiquimod and at follow-up she is disease-free. The fourth case involved a 64-year old woman complaining of vulvar itching and burning for about 8 months. She was initially treated with
imiquimod but due to disease persistence she had a hemivulvectomy. At follow-up she has signs of VPD but declines any other treatment.
Conclusion(s): We report four cases of VPD. The clinical features of VPD were similar and the treatment was dictated by the vulvar lesion size, the multidisciplinary team consensus, and the patient’s choice.