Extramammary Paget disease - Anogenital in
Males are less frequently diagnosed with EMPD than women, except in Japan where there is a male preponderance.
EMPD most frequently presents in men on the anogenital area. Lesions are often banal in appearance and similar to that of eczematous dermatoses, leading to delays in diagnosis. Symptoms may be minimal to none; sometimes, there is itch, pain, or burning. Presentation is typically of a red, sharply-demarcated plaque that expands slowly. Areas within the plaque are marked by erosions and white scale, leading to the appearance of "strawberries and cream."
Approximately 10% of patients with a new diagnosis of EMPD are diagnosed with a noncontiguous associated malignancy within 12 months of diagnosis. An additional 10%-25% of patients have a contiguous malignancy at the time of diagnosis. The most commonly associated malignancies in men are cancers of the prostate, urinary tract, and rectum. Due to these associations, a thorough investigation for underlying malignancy should accompany every diagnosis. The site involved predicts the site of secondary malignancy. For example, scrotal, anal, and colorectal disease shows an increased risk of scrotal, anal, and colorectal malignancy, respectively.
C44.99 – Other specified malignant neoplasm of skin, unspecified
71447003 – Paget's disease, extramammary (except Paget's disease of bone)
Differential Diagnosis & Pitfalls
- Allergic / irritant contact dermatitis
- Seborrheic dermatitis
- Lichen simplex chronicus
- Bowen disease
- Basal cell carcinoma
- Tinea cruris
- Hailey-Hailey disease
- Lichen sclerosus
- Lichen planus
- Erythroplasia of Queyrat
- Glucagonoma syndrome
- Pemphigus vegetans
- Pagetoid dyskeratosis
- Clear cell papulosis
- Langerhans cell histiocytosis