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Extramammary Paget's Disease

What is Extramammary Paget's Disease?

Extramammary Paget Disease (EMPD) is a skin malignancy that affects the outer layer (epidermis) of the skin in areas that are rich in apocrine sweat glands. Apocrine sweat glands are a type of sweat gland that is found in areas with an abundance of hair follicles. EMPD presents as a rash in areas such as the external part of the female genitalia or vulva, penis, the skin covering the testicles or scrotum, and the skin surrounding the genitalia and the rectum. In most cases, the rash is well-defined, red, scaly, and itchy. In one-third of the affected individuals, the rash is associated with underlying cancer.



  • Extramammary Pget Disease

Extramammary Paget Disease (EMPD) is a skin malignancy that affects the outer layer (epidermis) of the skin in areas that are rich in apocrine sweat glands. Apocrine sweat glands are a type of sweat gland that is found in areas with an abundance of hair follicles. EMPD presents as a rash in areas such as the external part of the female genitalia or vulva, penis, the skin covering the testicles or scrotum, and the skin surrounding the genitalia and the rectum. In most cases, the rash is well-defined, red, scaly, and itchy. In one-third of the affected individuals, the rash is associated with underlying cancer.

Acknowledgement of Extramammary Paget's Disease has not been added yet.

The exact prevalence of EDMP is unknown, and only a few hundred cases have been reported. It predominantly affects women and those of Caucasian descent. The most common age of onset is 50-80 years of age. 

Name Abbreviation
Extramammary Pget Disease EDMP

Primary EDMP is the abnormal growth of a specific type of cancer cells, called Paget cells. Paget cells develop at the outermost layer of skin (epidermis) around sweat glands and lead to the formation of the rashes that characterize EDMP. Although this type is not caused by underlying cancer, it can penetrate the deeper layers of skin and affect other sites. Secondary EDMP is associated with other cancers and is believed to form when underlying cancer in the deeper layers of the skin or internal digestive, reproductive, or urinary organs spreads to the epidermis. 


The most common symptom of EMPD is the presence of rashes around the genital or anal area. These rashes are often red, scaly, with clear borders, and sometimes ulcerated. These rashes are most commonly itchy, but some individuals experience burning and tenderness. The affected areas usually expand slowly. The most frequently affected region is the external female genitalia (vulva), but the skin around the anus and the male genitalia (penis and scrotum) are also relatively common. Rarely, axilla, cheeks, and external ear can be affected. In some cases, lymph nodes, which are parts of the immune system, may also be affected and become enlarged.


The diagnosis of EMPD requires a detailed physical examination including skin examination, lymph node palpation to check for enlarged lymph nodes, and breast and rectal examination. If EMDP is suspected, skin biopsy usually confirms the diagnosis.

A skin biopsy is usually performed to confirm the diagnosis of EMPD. In a skin biopsy, a small piece of the affected skin is removed and sent to be examined under a microscope. Paget cells have a well-defined appearance and can be recognized under a microscope. After the diagnosis of EMPD is confirmed, a series of tests are done to assess the presence of underlying cancer. These tests include mammography, gynecologic tests such as colposcopy, pap smear, pelvic ultrasound, colonoscopy, and cystoscopy. These tests check the breast tissue, the female reproductive tract, the large intestine, and the urinary tract, respectively, for underlying cancer or abnormality.

The standard treatment of EMPD is surgery. There are several surgical options for this condition. Mohs micrographic surgery is a procedure to treat skin cancer where cancerous skin layers are progressively removed until only healthy skin is present. If the EMPD affects the vulva, a vulvectomy may be performed where all or parts of the vulva are removed. Although surgery is the standard treatment, less invasive therapies may also be used before or after surgery. Radiation therapy may be used in combination with surgery. In this case, high-energy radiation is used to kill tumor cells. Another form of treatment that has been used in EDMP is photodynamic therapy. In photodynamic therapy, visible light is shone on a photosensitizing agent on the skin. A photosensitizing agent is a compound that absorbs light and generates free radicals. These free radicals can destroy cancer cells.

The prognosis of EMPD is highly variable and depends on multiple factors. The prognosis is better when only the outer layer of the skin (epidermis) is involved, the lymph nodes are not affected, and no underlying cancer is present.

Tips or Suggestions of Extramammary Paget's Disease has not been added yet.

Genetic and Rare Disease Information Center. Extramammary Paget disease. Available from 


Jimmy Yu Wai Chan, George Kam Hop Li, Joseph Hon Ping Chung, and Velda Ling Yu Chow, "Extramammary Paget's Disease: 20 Years of Experience in Chinese Population," International Journal of Surgical Oncology, vol. 2012, Article ID 416418, 5 pages, 2012.


McDaniel B, Crane JS. Extramammary Paget Disease. [Updated 2019 Aug 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from:


Stanford Healthcare. Extramammary Paget's Disease. Available from


Lam C, Funaro D. Extramammary Paget's Disease: Summary of Current Knowledge.

Dermatologic Clinics. 2010;28(4): 807-826. 10.1016/j.det.2010.08.002


Bae JM, Choi YY, Kim H, et al. Mohs micrographic surgery for extramammary Paget disease: a pooled analysis of individual patient data. J Am Acad Dermatol 2013;68:632–7.


Nardelli AA, Stafinski T, Menon D. Effectiveness of photodynamic therapy for mammary and extra-mammary Paget's disease: a state of the science review. BMC Dermatol. 2011;11:13. Published 2011 Jun 15. DOI:10.1186/1471-5945-11-13


Dr. Sandra Lee May Be Able to Help Created by DermaDean
Last updated 30 Apr 2021, 08:49 PM

Posted by DermaDean
30 Apr 2021, 08:49 PM

My name is Dean Donofrio and I am a Casting Producer for a show on TLC called “Dr. Pimple Popper”, with renowned dermatologist Dr. Sandra Lee. She has been fixing people’s skin problems for years, and amassed a huge following on youtube before they gave her a show on TLC. 


I want to tell Dr. Lee about this syndrome to see if she can help you. If you’re selected to get treatment by her, it would be at NO COST to you, including a FREE FLIGHT to her office in California.


Here is a link to the show: 

Our casting page: 


If you want to know more about this, reply here or email me at with your story and some pics of your condition.

Community Details Update Created by RareshareTeam
Last updated 15 Oct 2019, 10:36 PM

Posted by RareshareTeam
15 Oct 2019, 10:36 PM

Hi everyone,

The Extramammary Paget Disease community details have been updated. We added more information about the cause, prevalence, symptoms, diagnosis, and treatment. Hopefully, you find it helpful. 

Surgery Created by Dianekm
Last updated 24 Aug 2010, 02:19 PM

Posted by Sumie729
24 Aug 2010, 02:19 PM

Dianekm, Glad you had successful surgery. Dr Sutton will have your pathology report and will give you instructions on your course of action. I am confident that he did the same surgery for you that he did for me, where he injects you with a dye and takes you in a dark room and draws around the area that lights up. I had clean margins and he said that was rare. As far as healing, it does take a long time to heal. I found that sitting on ice packswas helpful, I wore loose fitting pants (like the travel knit pants)and used our jaccuzi bath tub. Hang in there, it takes a long time for it to fully heal. The last surgery I had was a very large area and the area that took the longest was the Perineum area. I was close to having skin grafts To answer EMPD, I had two surgeries, not because it came back, but because my first doctor did not remove all the EMPD. I have not had an occurance since my last surgery 2.5 years ago. I am examined by my gyn and Dr Sutton annually.

Posted by EMPD
24 Aug 2010, 05:31 AM

Was your surgery MOHS? My MOHS perianal surgery took 4 months to heal. I'm sure it depends on where and how much tissue was removed. All the lit. says this EMPD skin cancer often returns. The cells are like a crab. It digs down and then appears outside of the incision line, I have read that its important to have slides of the tissue removed read by a patholigist to make sure all of the cancer cells have been removed. Don't rely on assistants guessing if you need check ups. Get someone who is familiar with the research make recommendations as to how often you should be check for re-accurances. I have check ups every 6 months now. If anything looks questionable a biopsy is needed. My slides are review by a path specialist in a university setting. I was told if my check ups show negative results, we can wait longer inbetween checkups. I have my GYN do the checkups. She can use the colpascope to examine the area. Did you have all other areas of suspeced cancers checked out. i.e. bladder, vagina, rectum, colon, etc. This cancer can be a second site of simular tissue. Pain management is a very big issue to us Pagets patients. The area is prone to infection as well as a LOT of pain. That skin has a lot of nerve endings. :^( Its important for everyone to be followed by a doctor until its completly held. Several of us think this condition should be very closely monitored by home health or cared for in a hospital setting. How do each of you feel about this last statement??? The doctor I went to at M.D. Anderson is no longer there. He as a MOHS specialist and got several cases of Pagets a year. Its upsetting that there is not a "recommended protocal that all surgeons use. People, our treatment should not be a guessing game. There are a few studies that show different results. We want the treatment that gives us the best chance of no re-occurances. How many of you have had more that one surgery or treatment? How far apart were they? What was your treatment? What is the longest time you have not had any re-occurance? Is any research collecting the results of EMPD pts in the US??

Posted by Dianekm
24 Aug 2010, 01:43 AM

Hello, I am a 47 year old female that was diagnosed with Extramammary Paget's disease last month. I had a partial vulvectomy and it is taking awhile to heal. I was wondering if anyone had any good tips on healing. I wanted Sumi to know that I also went to Dr. G. Sutton in Indianapolis and have been pleased with him so far. Although he went on vacation right after my surgery and I have not seen him again. I was wondering if Dr. Sutton did followup testing on you. So far his assistants did not feel it was necessary.

Doctors reaction Created by Sumie729
Last updated 23 Mar 2010, 08:10 AM

Posted by Marilyn
23 Mar 2010, 08:10 AM

Has anyone called or used a doc at the Mayo Clinic?

Posted by Sumie729
22 Mar 2010, 08:05 PM

I truly feel that patients that have just received their new diagnoses should seek a second opinion. I wish I had. I think I was so overwhelmed with the diagnoses that I just did whatever this doctor told me to do, and also as I was sitting in the doc’s waiting room, I would listen to stories about how this oncologist was their last hope, they had come from different states to see him. I felt as if he didn’t think my disease was as important as his other patients. (Thanks for listening) That first Doctor was Dr. David Moore in Indianapolis, IN. The second doctor that I felt did an awesome job was Dr. Gregory Sutton in Indianapolis, IN. He sent me FIRST to Dr. Hankee a laser skin and surgical doctor to try alternative treatments. We first tried the Aldrea cream, which had no effect at all. The second treatment was Photodynamic Therapy. I received 2 treatments with no results. The funny thing about going to this office, they didn’t even know they had stirups on their exam tables. I then went back to Dr. Sutton, he performed surgery with intravenous dye to see where the cancer outline was and then he went outside the margin. I have been EMPD free for 2 years. I go annually for exams. I hope this information is helpful to others

Posted by Marilyn
20 Mar 2010, 04:44 AM

I found out a few months ago that the doctor that did my MOHS surgery is no longer at M.D. Anderson. He is still in the Houston area, but I do not know if he is or would be willing to do more MOHS surgery on any more pts with EMPD. I think it might be time for us to post the area and doctors names that we think did a good job of surgery as well as proper cancer removal. We have posted several types of treatment and lengths of return of Paget cells. I will start this list with my Pagets being in the Pari anal area with MOHS surgery done to try and move all cells that were found on slides. I was instructed to start using the Aldara cream as soon as my skin was totally healed in hopes of the cream stimulating my immune system to attack any cells that return or show up underneath. I should be visually checked every 3 months. Have biopies done when ever there is a question or concern. Most of us had a thourough check up on body parts that could have cancers in other areas. I.E. Bladder, uterus, rectum, colon etc. Has anyone had a check up on their small colon? That seems to be the hardest to check on. There is a colon video cam pill that can take pictures of the small colon, but I have not heard of any of us having that. I think insurances do not pay for this test yet. But maybe if it was explained about our condition they might. I wonder how much it woul;d cost for us to pay out of pocket. Also I noticed that most of us have not posted in a while. I'm sure with dealing with our own health and wanting to try to forget about it as much as possible posting and searching is not a priority. Most of my computer time looking for info was before I had treatment. So if that is your case too, then newbies will be reading the most. So I would like to know where you are happy with your treatment and doctor, so I will have a plan if mine returns. Selfish arn't I. :^) Thanks to you all and I wish you the best. We are a support group as well as a FORCE if we continue to be a group. take care Marilyn

View Full Thread (1 more posts)
coping Created by mruiz
Last updated 23 Mar 2010, 05:02 AM

Posted by photoladyLM
23 Mar 2010, 05:02 AM

Hello! I thought I'd check in since a few others have lately. Just to give you an update on my husband, Mark. He went through six weeks of daily radiation therapy after his last positive biopsies (fall of 2008). The radiation finished in January of 2009 and he just had another recheck at the oncologist in March 2010 and is still clear of EMPD (this is the longest stretch of "clear" that he's had since being diagnosed). The side effects from the radiation weren't pleasant but he's still happy that he took that route instead of more surgeries or using the all-but-worthless creams (in his particular case) that he tried repeatedly. I don't think there have been many cases treated with radiation but you do need to know that it's an option. Take care!

Posted by Marilyn
19 Mar 2010, 06:00 PM

Hi Dave, its Marilyn. Nice to hear from you. We should talk on the phone. I'm at home until Monday am. 541 536 1239 Still in Oregon, but will be traveling down to Calif to scatter my moms ashes near Santa Barbara. I have been very busy this year and just had two more negative biopsies. Have not started the aldara yet. I just can not face an open sore down there at this time. Seems like I just got healed up and am hoping for a short while without any medical issues and pretend life is normal again.

Posted by Sumie729
18 Mar 2010, 08:06 PM

I have had surgery by a gyno oncologyst in 2006, the doc did not remove all the area, and did not discuss it with me... to my suprise after a partial vulvaectomy I found I would have to go for more surgery and possible skin graft. Decided to get a second opion, went to a second doc, we discussed surgery and he referred me to a Dermatologist who specializes in Mohs surgery, we tried Aldera and it did not work at all, he then did laser treatment which also did not work. Went back to the gyno oncologist, he did a radical vulvaectomy and removed a very large area of my buttock, did not use grafts and also before surgery, injected me with a dye, brought me into a dark room with a balck light, the dye lights up the cancer cells, he drew around the cancer cells and did surgery beyond the marked area. The margins came back clean. I have not had a reoccurance in 2 years. Let me know how you have made out.

View Full Thread (8 more posts)
Rash on back Created by sokar_43
Last updated 5 Oct 2009, 02:01 AM

Posted by sokar_43
5 Oct 2009, 02:01 AM

I had two very small ecema like lesions on my upper left back biopsied and it came back adenocarcinoma EMP. I have no other symptoms. I did have a rare pancreatic cancer six years ago and had a distal pancreatectomy with good results. I'm perplexed at the location of these findings and also wonder if it is a recurrence of my PC.

updates ? Created by EMPD
Last updated 13 Sep 2009, 05:43 AM

Posted by photoladyLM
13 Sep 2009, 05:43 AM

Just a note to give a quick update on Mark's condition. I am thankful to say that he's had 8 months "EMPD free" since he finished his radiation treatments in January. Although he still doesn't seem to be back up to full power (they said it could take up to a year) it has been so nice to not have to battle with treatments, creams & surgeries for a few months after the two-plus years we were trying each option that the doctors presented. I hope everyone else is doing well too!

Posted by EMPD
13 Sep 2009, 01:47 AM

Wonderful up date, thank you for all your research. I too had the same result from the Aldera. But I was told this might happen and that ment that it was working. I started 4 or 5 different times to use it as told. When I check in with my dermatologist, he suggested I try less often, i.e. 2 times a week. I will try this next.

Posted by fhall
13 Sep 2009, 01:32 AM

Hello Everyone! About 3-4 months ago, my 89 year old mother was diagnosed with EMPD. Best estimate is that she's had it for 25 years or more, completely asymptomatic with the exception of redness of the vulva. No itching, no lesions, no "nothing". Nothing, until she recently had an absessed tooth that required penicillin as treatment. The penicillin made the vulva itching unbearable. After annual check ups for 25+ years, always responding that she guessed the redness was a birthmark (and NO further investigation from any MD!!!), the OB/Gyn she saw for the itching immediately recognized that there was a serious problem and recommended biopsy. Mom had a second opinion, who basically said the same thing. A biopsy was done, and a diagnosis of EMPD came. As you may understand, I immediately responded with a a whirlwind of research, thanks to the Internet. At her advanced age, Mom was completely against surgery, chemo or radiation. Consequently, I was looking for informaiton about the condition, what we could expect of its future and any non-invasive treatment. Fairly quickly, I found several research projects using Aldera (Imiquimod) in conjunction with and/or in lieu of surgery. Boldly, I emailed all researchers in the US. Graciously and compassionately, I heard from several, including a phone call from Dr. Yi in California and a referral from Dr. Ken Hatch in Arizona to Dr. R. Wendel Naumann in Charlotte, NC (near my home). Mom is now under Dr. Naumann's care. Thankfully, he concurred that surgery for Mom was not reasonable and was willing to prescribe Aldera for her in lieu of surgery. Mom is having a great deal of difficulty with the Aldera -- severe burning creating open lesions, etc. (She alternates self-applied treatment days -- Aldera on Monday, Wednesday and Friday, and a steroid treatment on Tuesday, Thursday, Saturday and Sunday.) Mom is not at all sure that she will continue with the treatment. She has already had to stop Aldera twice after three treatments because of the discomfort. As she will be 90 in December, the discomfort may simply be more than she is willing to bear. Without question, surgery is still the most accepted treatment. However, more and more research is being done -- around the world -- using Aldera as an alternative treatment. Sloan-Kettering (in NY) is doing a clinical trial on Aldera in lieu of surgery at the NY campus as well as LSU (Louisiana State University). Regardless of Mom's outcome, I will forever be glad that I found a treatment that she was willing to try. I will also forever be grateful for Dr. Yi's, Dr. Hatch's and Dr. Naumann's compassion, integrity and clinical expertise, as well as their tireless efforts to offer solid, appropriate, non-invasaive medical intervention. As Dr. Naumann's RN told me, look to NIH (National Institute of Health) for solid medical information, rather than other Internet sites. Although well-intended, many websites offer misleading (or simply incorrect) information. I am glad, however, that my research uncovered alternative work being done on EMPD, helping me learn more about the disease and putting me in touch with physicians across the US who, with great compassion, have been helpful, encouraging and supportive. I know this is long ... but I suspect that all who are dealing with EMPD want to know about all possibilities. I share our story in hope that it will encourage and support someone along the journey.

View Full Thread (1 more posts)
American Cancer Society Created by EMPD
Last updated 5 Aug 2009, 05:49 PM

Posted by EMPD
5 Aug 2009, 05:49 PM

folks, I spend some time talking to a oncology nurse at the ACS. The subject was why we had such difficulty find good info on EMPD. She said there phone staff are trained to take a phone number and get back to them if there are still questions they can not answer. Then that info is passed on to someone who has more sources to research for us. A oncology nurse called me back and gave more info on site to look at. One site that we can always us is Emedicine. As you know, some journals are protected with copywrite articles and we would have to pay. If we find an article that we can not read due to protections, just give them a call. They have access to many we as layman do not. One that same vein, if you have found very useful info, please post it for all to read. You all take care and I wish you the best.

Loki Created by EMPD
Last updated 4 May 2009, 07:24 AM

Posted by EMPD
4 May 2009, 07:24 AM

I explained my condition to people this way. In layman terms: I have a very rare skin cancer. Its of the pheramone sweat glands. There are only a few hundred cases reported in the literature in the whole world. At this time the cause is undetermined. This tissue is found on the breast, vulva, anal, perianal, scrotum, penis, ears and eye lids. This cancer has a high rate of returning outside, but near the treated area. Hence, its very important that all efforts be made to clear the edges of any remaining cancer cells. I was told by my local docs and my M.D. Anderson doc, "Its VERY important to determine, before treatment, that this is not a second site of a primary cancer in the vagina, bladder, rectum, intestine etc." As then a different surgery may be performed to include all cancer sites, not just the surface skin. After the inital treatment, the pt. should return at regular intervals to check for any return of this disease. So this condition is a ongoing cronic condition that has to be watched. Yes it is confusing, frightening and uncertain. That is why this little group of folks that have been thru it already is important. We can understand what you are going thru. Be compassionate about your concerns and fears. You are young, you have a condition that no one you know has ever heard of. You do not know what your experiences will be and what the treatments will be like. We have formed a little group that might be able to be there for you during and after your treatments. So write to us any time you feel the need, or call any of us that posts our phone #s. ??When is your surgery planned? Is the plan for you to stay in the Hospital? Do you have someone to help you with wound care when you get home? Do you have an idea as to how long it will take to heal? So the docs plan on using Aldera cream after you heal? Hope to hear from you soon and good luck to you. Call anytime. EMPD

Articles on EMPD Created by EMPD
Last updated 4 May 2009, 06:45 AM

Posted by EMPD
4 May 2009, 06:45 AM

I found that this web site is a good article for anyone with EMPD to read. Especially before treatment is possible. If anyone else has any to add, lets start a list of references for anyone new to this subject. Marilyn

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After these steps, the enrollment process is complete. All other questions are voluntary. However, these questions are important to patients and their families to create awareness as well as to researchers to study rare diseases. This is why we ask our participants to update their information annually or anytime changes to their information occur.

Researchers can contact CoRDS to determine if the registry contains participants with the rare disease they are researching. If the researcher determines there is a sufficient number of participants or data on the rare disease of interest within the registry, the researcher can apply for access. Upon approval from the CoRDS Scientific Advisory Board, CoRDS staff will reach out to participants on behalf of the researcher. It is then up to the participant to determine if they would like to join the study.

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47 year old female just diagnosed with Extramammry Pagets Disease.


Looking for others experiences
I have Extra Mammary Padget's Disease and have had two vulva excision, one in 2006 the other in 2008.
My almost-90 year old mother has just been diagnosed with EMPD. Looking for any and all information about appropriate treatments, what to expect, doctors and clinics/hospitals with EMPD experience....
Extramammary Paget's disease of Vulva
I have EMPD of the vulvar area. Had big operation in March 2008. Still have positive biopsies. Have not started Aldera because I am uncertain about side effects. If anyone has any info about Aldera...
I am a 68 year old female. Was DX with EMPD about three months ago. Am having MOHS skin surgery in late Oct.



M. D. Anderson Cancer Alliance in Houston. After healing from surgery, I...

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Discussion Forum

Dr. Sandra Lee May Be Able to Help

Created by DermaDean | Last updated 30 Apr 2021, 08:49 PM

Community Details Update

Created by RareshareTeam | Last updated 15 Oct 2019, 10:36 PM


Created by Dianekm | Last updated 24 Aug 2010, 02:19 PM

Doctors reaction

Created by Sumie729 | Last updated 23 Mar 2010, 08:10 AM


Created by mruiz | Last updated 23 Mar 2010, 05:02 AM

Rash on back

Created by sokar_43 | Last updated 5 Oct 2009, 02:01 AM

updates ?

Created by EMPD | Last updated 13 Sep 2009, 05:43 AM

American Cancer Society

Created by EMPD | Last updated 5 Aug 2009, 05:49 PM


Created by EMPD | Last updated 4 May 2009, 07:24 AM

Articles on EMPD

Created by EMPD | Last updated 4 May 2009, 06:45 AM


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