Paget's Disease Of The Scrotum: Diagnosis And Management(12 Cases Report)

Objective: To investigate the clinical features,diagnosis,management and the prognosis of the Paget's disease of the scrotum.Methods: The clinical features,diagnosis,management and the prognosis of the 12 patients with Paget's disease of the scrotum at the First Affiliated Hospital of Guangxi Medical University from March 2003 to December 2016 were reviewed and analyzed retrospectively.Result: All of the 12 patients were male.The mean age was 67.9 years(range: 55 to 91).The typical local clinical features were itching,erythema,erosion and seepage from the skin of the scrotum and it's surroundings.Of the12 patients,3 cases had local lesion on the scrotum,other 9 cases had wide spread lesions.2 patients had bilateral inguinal lymph node enlargement.Preoperative mapping biopsy was performed in 12 cases and all the patients were confirmed to suffer from Paget's disease of the scrotum.Among them,3cases were in A1 period and 9 were A2.Wide local excision of lesions was performed in 9 cases,while inguinal lymph node biopsy was performed in 1case.Direct suture,flaps and skin grafts were performed in the reconstruction of penoscrotal defects.One case with inguinal lymph node enlargement was confirmed to had no metastasis to the inguinal lymph node by biopsy.The defects of 3 cases had poor healing and received II stage debridement andsuturing.One case with surgical treatment received systemic chemotherapy postoperatively.3 cases went through conservative management received radiotherapy,photodynamic therapy,systemic and local chemotherapy depending on the severity of the case.A total of 9 cases were followed up after hospital discharge and 3 cases were lost.The mean follow-up duration was 29.2months(1-67 months).For all the 9 cases,no recurrences or metastasis were found during the follow-up period.Conclusion: As the clinical manifestations is lack in specificity,the misdiagnosis rate is high for Paget's disease of the scrotum.Wide local excision of lesions is the preferred management and the prognosis is excellent.Early diagnosis and management with long term follow-up are the keys to excellent prognosis.