Yang Jing, Yan Jianna, Luo Hao, Li Liang, Jiang Long, Chen Xuewen, Wu Ling, Chai Jingxiu, Xue Huan, Gan Leimeng, Liu Yeqiang, Chen Jia, Fei Wu, Bai Yun, Zhu Quangang, Chen Zhongjian, Guo Lehang, Chen Yuchong
Department of Surgery, Shanghai Skin Disease Hospital Affiliated to Tongji University, Shanghai, People's Republic of China.
Department of Pathology, Shanghai Skin Disease Hospital Affiliated to Tongji University, Shanghai, People's Republic of China.
Clin Cosmet Investig Dermatol. 2025 Jul 29;18:1791-1799. doi: 10.2147/CCID.S516022. eCollection 2025.
To investigate the clinical efficacy of narrow-margin modified Mohs microsurgery (mMMS) in the treatment of extramammary Paget's disease (EMPD).
A retrospective cohort review was conducted on 52 patients with EMPD who were treated at the Skin Disease Hospital of Tongji University in Shanghai between 2017 and 2023. The primary objectives of this study were to assess the long-term local recurrence rates of tumors treated with narrow-margin mMMS and to explore the final margin width as well as the factors that may influence postoperative recurrence.
A total of 52 patients were included in this retrospective study. Most patients were male (n = 48, 92.3%) with a mean age of 69.5 years (SD:9.08, range:44-91). The follow-up rate was 78.7% (41/52), and the mean follow-up time was 36.17 months (SD:18.25, range 5.8-62.5). The recurrence rate was 9.7% (4/41) and the 5-year tumor-free rate was 85.9%. Approximate 95% of tumors with 1 cm of non-scrotal skin extension or 1.5 cm of scrotal skin extension could be completely cleared. Univariable analysis revealed that hypopigmented patches (HR=14.0, 95% CI=1.269,154.395, p = 0.031) correlated with tumors recurrence.
Narrow-margin mMMS is the ideal therapy combine a disease control rate with more satisfying functional results. Determination of tumor boundaries requires attention to skin lesions with hypopigmented macules. The initial resection margins width of the extension cut can be reduced in non-scrotal skin lesions at the time of surgery to minimize pointless margin expansion.
探讨窄切缘改良莫氏显微外科手术（mMMS）治疗乳房外佩吉特病（EMPD）的临床疗效。
对2017年至2023年期间在上海同济大学皮肤病医院接受治疗的52例EMPD患者进行回顾性队列研究。本研究的主要目的是评估窄切缘mMMS治疗肿瘤的长期局部复发率，并探讨最终切缘宽度以及可能影响术后复发的因素。
本回顾性研究共纳入52例患者。大多数患者为男性（n = 48，92.3%），平均年龄69.5岁（标准差：9.08，范围：44 - 91岁）。随访率为78.7%（41/52），平均随访时间为36.17个月（标准差：18.25，范围5.8 - 62.5个月）。复发率为9.7%（4/41），5年无瘤生存率为85.9%。约95%的非阴囊皮肤延伸1 cm或阴囊皮肤延伸1.5 cm的肿瘤可被完全清除。单因素分析显示，色素减退斑（HR = 14.0，95%CI = 1.269，154.395，p = 0.031）与肿瘤复发相关。
窄切缘mMMS是一种理想的治疗方法，可将疾病控制率与更满意的功能结果相结合。确定肿瘤边界时需注意伴有色素减退斑的皮肤病变。手术时非阴囊皮肤病变延伸切口的初始切除边缘宽度可减小，以尽量减少无意义的边缘扩大。
