Jing Yang,1,* Jianna Yan,1,* Hao Luo,1 Liang Li,1 Long Jiang,1 Xuewen Chen,1 Ling Wu,1 Jingxiu Chai,1 Huan Xue,1 Leimeng Gan,1 Yeqiang Liu,2 Jia Chen,3 Wu Fei,2 Yun Bai,4 Quangang Zhu,5 Zhongjian Chen,5 Lehang Guo,6 Yuchong Chen1 

1Department of Surgery, Shanghai Skin Disease Hospital Affiliated to Tongji University, Shanghai, People’s Republic of China; 2Department of Pathology, Shanghai Skin Disease Hospital Affiliated to Tongji University, Shanghai, People’s Republic of China; 3Department of Rheumatology and Immunology, Shanghai Skin Disease Hospital Affiliated to Tongji University, Shanghai, People’s Republic of China; 4Department of Central Laboratory, Shanghai Skin Disease Hospital Affiliated to Tongji University, Shanghai, People’s Republic of China; 5Department of Pharmacy, Shanghai Skin Disease Hospital Affiliated to Tongji University, Shanghai, People’s Republic of China; 6Department of Ultrasonography, Shanghai Skin Disease Hospital Affiliated to Tongji University, Shanghai, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Yuchong Chen, Department of Dermatologic Surgery Division, Shanghai Skin Disease Hospital Affiliated to Tongji University, Shanghai, People’s Republic of China, Email 973309637@qq.com

Background: To investigate the clinical efficacy of narrow-margin modified Mohs microsurgery (mMMS) in the treatment of extramammary Paget’s disease (EMPD).
Methods: A retrospective cohort review was conducted on 52 patients with EMPD who were treated at the Skin Disease Hospital of Tongji University in Shanghai between 2017 and 2023. The primary objectives of this study were to assess the long-term local recurrence rates of tumors treated with narrow-margin mMMS and to explore the final margin width as well as the factors that may influence postoperative recurrence.
Results: A total of 52 patients were included in this retrospective study. Most patients were male (n = 48, 92.3%) with a mean age of 69.5 years (SD:9.08, range:44– 91). The follow-up rate was 78.7% (41/52), and the mean follow-up time was 36.17 months (SD:18.25, range 5.8– 62.5). The recurrence rate was 9.7% (4/41) and the 5-year tumor-free rate was 85.9%. Approximate 95% of tumors with 1 cm of non-scrotal skin extension or 1.5 cm of scrotal skin extension could be completely cleared. Univariable analysis revealed that hypopigmented patches (HR=14.0, 95% CI=1.269,154.395, p = 0.031) correlated with tumors recurrence.
Conclusion: Narrow-margin mMMS is the ideal therapy combine a disease control rate with more satisfying functional results. Determination of tumor boundaries requires attention to skin lesions with hypopigmented macules. The initial resection margins width of the extension cut can be reduced in non-scrotal skin lesions at the time of surgery to minimize pointless margin expansion.

Keywords: extramammary Paget’s disease, modified Mohs microsurgery, retrospective study, recurrence, hypopigmented patches