Local Recurrence Rates of Extramammary Paget Disease Are Lower After Mohs Micrographic Surgery Compared With Wide Local Excision: A Systematic Review and Meta-Analysis. Issue 1 (6th January 2023)

• Record Type: Journal Article
• Authors: Kim, Grace Y.; Campbell, Elliott H.; Brewer, Jerry D.
• Is Part Of: Dermatologic surgery. Volume 49:Issue 1(2023)
• Page Start: 8
• Page End: 12
• Publication Date: 2023-01-06
• Subjects: Skin -- Surgery -- Periodicals; Skin -- Diseases -- Surgery -- Periodicals; 617.477
• DOI: 10.1097/DSS.0000000000003601
• Languages: English
• ISSNs: 1076-0512

Abstract

Abstract : Supplemental Digital Content is Available in the Text. Abstract : BACKGROUND: Extramammary Paget disease (EMPD) is a rare, slow growing neoplasm that presents most commonly in the anogenital region of older adults. OBJECTIVE: To analyze the difference in local recurrence rates of EMPD in patients treated with wide local excision (WLE) versus Mohs micrographic surgery (MMS). MATERIALS AND METHODS: A systematic review of the literature and meta-analysis were performed. Inclusion criteria were adults greater than 18 years of age with a diagnosis of EMPD who have undergone surgical intervention and had follow-up data. Studies were independently reviewed by 2 coinvestigators with discrepancies resolved by the principal investigator. RESULTS: Twenty-seven studies met the inclusion criteria. Patients had a 2.67 times higher chance of local recurrence after WLE than MMS (95% confidence interval [CI]:1.47, 4.85; p = .001). Meta-analysis of single-arm studies revealed a 7.3% local recurrence rate after MMS (95% CI: 0.039, 0.107; p < .001) versus a 26.3% recurrence rate after WLE (95% CI: 0.149, 0.376; p < .001). After excluding recurrent tumors, the odds ratio for recurrence in WLE versus MMS was 2.3 (95% CI: 0.285, 18.43, p = .435). CONCLUSION: There is a clinically and statistically increased risk of local recurrence of EMPD after WLE compared with MMS.