Hello, Naomi: I had several spots all around the vulva area the last three years since the discovery, so my oncologist said surgery is not an option right now. Yes the treatment seems to keep things in check, but I am wondering about why the "manifestations" are coming so often. She has told me several times when I start to worry that, as long as I treat the new spots, I should be fine. Since EMPD can be found in the breast, I asked her if my disease could be spreading to the breast and she did not think so, but then again there seems to be not enough evidence or research.