← Return to Rare Cancer: Gynecologic Extramammary Paget's Disease

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@scintillation

Hi everyone - I was recently diagnosed with extramammary paget's disease of the vulva and I'm only 34 years old. Apparently this typically affects older people in their 60s+ but here I am and I have it. I wonder if there are any patients diagnosed and seen prolonged success with nonsurgical interventions like topical imiquimod, photodynamic therapy, lasers etc or how long those treatments were able to stave off eventual surgery. If there any other younger patients like me - also love to get your perspective on your experience and learn.

I still feel like I have at 30 years of good quality of life with my partner and still want to have kids before I have to consider a vulvectomy or any invasive radiation / excision that compromises my genital /reproductive areas and I'm pretty scared about it. Really want to try nonsurgical treatments if possible. Reading the scientific publications and speaking to my dermatologist - it seems the recurrent rates are still pretty high with these nonsurgical treatments Complete response could be somewhere between 30-50% for topical imiquimod cream but it seems it comes back in 30%+ of cases within a year or so. I'm still waiting to see if this is primary EMPD - so that it's localized to just the epidermis on my vulva and not that I have cancer somewhere else like breast, bladder, etc - which hopefully with my age is not the case.

Presentation/Diagnosis
I probably saw some epidermis/skin level change of the vulva changing close to 2 years ago but didn't think much of it since I was asymptomatic until I got an IUD inserted last year and my NP thought I had a yeast infection. It seemed to go away for my first treatment of fluconazole but then it kept coming back and I kept testing negative for candidiasis / yeast infection and the fluconazole they were giving me didn't seem to work anymore. It was also super itchy especially after having sex. It took my not being able to sleep one night that I was fed up and asked to be referred to an ob/gyn doctor where they finally took a biopsy for confirmation of extramammary paget's disease. They also originally those it was lichen simplus chronicus but my ob gyn took a biopsy just in case - thank goodness since it wasn't. So basically - almost a year from when my symptoms started and probably close to 2 years where i didn't have any itching symptoms but likely started seeing skin changes near my vulva. I did also test positive for HPV two years prior - but never for the high grade lesions - only low grade and this most recent pap smear I tested negative for HPV - just wondering if that had anything to do with getting EMPD. Anyone have a similar experience or had HPV history?

Referral Diagnosis
I went to a dermatologist who specializes in EMPD and she did 6 clock biopsies around my vulva including in areas that looks normal and unfortunately the 3 biopsies closest to my clitoris - were positive for CK7+ which is typically indicative of EMPD. In all three of those biopsies it was just on the edge of where I had the itchy patch so basically where my skin looked totally normal - it still tested positive for EMPD. My doctor is referring me to a ob gyn oncologist for further consult but vulvectomy including clitoris removal seems likely given how close the biopsies that tested positive were to my clitoris. We're going to start on the topical imiquimod for now but I don't feel optimistic it's going to work - primarily because it seems even if my skin looks normal - it tests positive for EMPD so I feel like I still have no idea how much to spread the topical treatment around my vulva since vulva that look normal but may still have paget's disease.

Any thoughts on that for folks who have tried it? Was planning to start it later this week. My doctor is recommending 2x a week for 3 weeks and then I have a follow-up. It seems like the side effects of itching / burning are not pleasant.
Also anyone else try photodynamic / red light therapy? or lasers? also saw those are options but not a lot of literature review / scientific articles with data on its efficacy.

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Replies to "Hi everyone - I was recently diagnosed with extramammary paget's disease of the vulva and I'm..."

Hi: just read what you wrote 5 days ago. I do have what you have and Imiquimod is how i have been treated since my first outbreak 3 years. I did have another outbreak almost a year ago. we tried to do things differently than 3 years to calm the side effects of Imiquimod when it comes to itching and burning. 3 years i had to put on the cream like every day and i could not cope with side effects so my oncologist said three times a week i think for another 3 weeks. then my visual yearly visit with a ob/gyn revealed not outbreak but last august i had an outbreak. I had 3 biopsies i think, and three years ago 4 i think. my oncologist put me right back on imiquimod but did 2 or 3 times a week for 8 weeks and i took some medication for the itching and i think a salve .. sorry not to remember too much. the two outbreaks made me tired and napping a lot. i am 68 and i have a lot of energy but not during treatment. about 25 years ago or so i had 3/4 of my cervix infected with HPV. I had the skin burnt. The dr. may not been deep enough. Tv ad says that HPV can cause vulvar cancer. My oncologist says that it is not proven. She seems to say that once you have EMPD on the vulva it does not go to the breast. She does check the thyroid on the hips to feel for growth. Three years ago, she was going to excise the clitoris but informed me that Imiquimod originally not for EMPD was able to control the outbreak. I am going to my OB/GYN on August 1 for another visual. Keep in touch. You are young and hopefully you may have your little family!

Sorry you are having to go through all of this and at such a young age! I wonder if you are symptomatic? The EMPD I have similarly is not showing up in visual exams. Only by biopsy. And because my docs have found (through multiple biopsies) that it exists on the top layer of skin only, they have offered to wait and observe before using any remedies, such as surgery or imiquimod. Both options are pretty difficult. Like you, they spoke of removing clitoris and other major structural changes. So waiting and observing is by far the best news I have heard. Since my EMPD is found to be “non invasive” at this time, anyway.