The University of Toledo Translation Journal of Medical Sciences 
Internal Medicine Abstract, Department of Medicine Research Symposium  UTJMS 2023 May 5; 11(1):e1-e1  
 

https://dx.doi.org/10.46570/utjms.vol11-2023-724   
 

A case of Extra Mammary Paget’s disease 
in a Geriatric Patient 
 
H. Shabpiray, MD1*, S. Iftikhar, MD, A. Garg, MD, G. Merugu, MD1, N. Aslam, 
MD1 
 

1Division of Internal Medicine, Department of Medicine, The University of Toledo, 
Toledo, OH 43614 
 
*Corresponding author: Hoda.Shabpirary@utoledo.edu  
 
Published: 05 May 2023 
 

Background: Paget’s disease is a rare form of adenocarcinoma of the breast. It involves apocrine gland-bearing 
skin that presents as a slowly expanding well-defined patch. It presents as an erythematous plaque on apocrine 
gland bearing areas including vulva, perineum, perianal region, scrotum, and penis. EMPD is a marginated plaque 
resembling Paget's disease and is very rare. We present a case with biopsy-proven EMPD in the left inguinal area 
which is an unusual area.    

 

Case Report: A 67-year-old male with a history of renal cell cancer status post left nephrectomy, diabetes, HTN 
and COPD presented with complaint of fatigue and 40 Ibs weight loss in 2 months. On physical examination, a 
suspicious erythematous plaque on his left inguinal region is noted. According to the patient, this lesion was 
present for several months and had recently increased in size. Skin biopsy was done that suggested invasive 
adenocarcinoma with pagetoid epidermal involvement of peripheral and deep margins. Surgery was consulted and 
a wide local excision of the left groin with sentinel lymph node biopsy was performed. The biopsy was positive 
for malignant cells. The patient is diagnosed with cutaneous invasive adenocarcinoma. Based on Ohara et al, his 
staging was pT1N1M0, stage IIIa. The patient underwent lymph node dissection. He was referred to medical 
oncology for discussion of the benefits and risks of systemic chemotherapy. Underlying malignancy was ruled out 
based on whole-body enhanced CT and colonoscopy. Since the patient was cancer free pathologically, it was 
recommended that he undergo routine follow-up every 6 months for 5 years postoperatively for surveillance.    

 

Conclusion: EMPD is considered an adenocarcinoma originating from the skin or skin appendages in areas with 
apocrine glands. The primary location is the vulvar area, followed by the perianal region, scrotum, penis and 
axillae. Commonly confined to the epidermis, EMPD can be invasive, associated with contiguous extension or 
upward pagetoid spread of underlying malignancy or with distant synchronous malignancy. Because of its 
association with other cancers, formal evaluation is warranted. Surgical excision remains the mainstay of 
treatment. Conventional chemotherapies have been used for the treatment in patients with distant metastases, but 
the efficacy is not satisfactory, and the prognosis for such patients is poor. 

 

https://dx.doi.org/10.46570/utjms.vol11-2023-724
mailto:Hoda.Shabpirary@utoledo.edu