Paget's disease of the vulva: Pathology, pattern of involvement, and prognosis

Lynn P. Parker, John R. Parker, Diane Bodurka-Bevers, Michael Deavers, Michael W. Bevers, Jane Shen-Gunther, David M. Gershenson

Research output: Contribution to journalArticle

169 Scopus citations

Abstract

Objective. The aim of this study was to determine prognostic factors and risk factors for recurrence in patients with Paget's disease of the vulva. Methods. The medical records of 76 patients with a diagnosis of Paget's disease of the vulva were retrospectively reviewed. The diagnosis in each case was confirmed by reviewing the pathology. Patients were then divided into four groups by diagnosis: intraepithelial Paget's disease (IEP) (n = 46), invasive Paget's disease (IP) (n = 9), intraepithelial Paget's disease with underlying adenocarcinoma (IEPUA) (n = 13), and intraepithelial Paget's disease with a coexisting cancer (CCA) (n = 8). Comorbid conditions, location of disease, pathologic diagnosis, method of treatment, margin status, and current status of the patient were evaluated. Descriptive statistical data and univariate analysis were generated using the Statview statistical package. Results. A diagnosis of IEPUA, IP, or CCA predicted a poor survival (P = 0.0017). Patients who had received chemotherapy or radiation as treatment had a poor survival (P < 0.0001 and 0.0002). Patients with clitoral Paget's disease had a higher incidence of death from disease (P = 0.026). When death from all causes was considered, patients treated with wide local excision (WLE) had a significantly longer survival than patients treated with other more radical treatments (P = 0.02). Risk factors for recurrence included treatment with WLE (P = 0.004). Conclusions. Patients with IP, IEPUA, or CCA have a poorer prognosis than patients with IEP. Location of Paget's disease is important for prognosis; and patients with clitoral Paget's disease may require more aggressive treatment. WLE is associated with a higher risk of recurrence, but overall patients with WLE tend to survive longer than patients treated more radically. (C) 2000 Academic Press.

Original languageEnglish (US)
Pages (from-to)183-189
Number of pages7
JournalGynecologic oncology
Volume77
Issue number1
DOIs
StatePublished - Apr 2000

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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