Anterolateral Thigh Island Flap Reconstruction After Margin-Positive, Sphincter-Preserving Excision of Scrotal Extramammary Paget’s Disease: A Case Report
- 1Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul 07441, Republic of Korea
Abstract
Background/Objectives: Extramammary Paget’s disease (EMPD) of the scrotum, a rare intraepithelial adenocarcinoma, closely mimics benign dermatoses and is often diagnosed only after years of unsuccessful topical treatment. Because tumor cells extend beyond the visible border, wide excision often leaves large defects and positive margins. When disease reaches the perianal skin, clearance may cost anorectal function. Case: A 69-year-old male had been treated for presumed scrotal eczema for 9 years before punch biopsy established EMPD extending from the scrotum across the perineum to the medial thigh and anal verge. After wide excision with a 2-cm margin, frozen section showed intraepidermal Paget cells at the perianal margin; because clearance risked sphincter resection, further excision was withheld. The continuous defect was reconstructed with an 18 × 12 cm anterolateral thigh (ALT) island flap. The flap survived completely. Medical oncology recommended surveillance, with radiotherapy or systemic therapy reserved for progression. The site remained stable at 6 months; the patient was then lost to follow-up untreated. Conclusions: When a positive margin is accepted to preserve function, tissue that can be re-elevated, tolerates irradiation, and leaves residual disease accessible to inspection is a reasonable choice, although this remains untested here and the oncologic outcome is unknown.
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BibTeX
@article{ahn2026anterolateral,
title = {{Anterolateral Thigh Island Flap Reconstruction After Margin-Positive, Sphincter-Preserving Excision of Scrotal Extramammary Paget’s Disease: A Case Report}},
author = {Jeonghun Ahn and Jin Sil Seo and Kyung Min Kim and Ki Hyun Kim and Jai Koo Choi and In Suck Suh and Seong Hwan Kim},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218508},
url = {https://www.mdpi.com/2077-0383/15/21/8508},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Anterolateral Thigh Island Flap Reconstruction After Margin-Positive, Sphincter-Preserving Excision of Scrotal Extramammary Paget’s Disease: A Case Report
AU - Jeonghun Ahn
AU - Jin Sil Seo
AU - Kyung Min Kim
AU - Ki Hyun Kim
AU - Jai Koo Choi
AU - In Suck Suh
AU - Seong Hwan Kim
PY - 2026
DA - 2026/11/02
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218508
UR - https://www.mdpi.com/2077-0383/15/21/8508
AB - Background/Objectives: Extramammary Paget’s disease (EMPD) of the scrotum, a rare intraepithelial adenocarcinoma, closely mimics benign dermatoses and is often diagnosed only after years of unsuccessful topical treatment. Because tumor cells extend beyond the visible border, wide excision often leaves large defects and positive margins. When disease reaches the perianal skin, clearance may cost anorectal function. Case: A 69-year-old male had been treated for presumed scrotal eczema for 9 years before punch biopsy established EMPD extending from the scrotum across the perineum to the medial thigh and anal verge. After wide excision with a 2-cm margin, frozen section showed intraepidermal Paget cells at the perianal margin; because clearance risked sphincter resection, further excision was withheld. The continuous defect was reconstructed with an 18 × 12 cm anterolateral thigh (ALT) island flap. The flap survived completely. Medical oncology recommended surveillance, with radiotherapy or systemic therapy reserved for progression. The site remained stable at 6 months; the patient was then lost to follow-up untreated. Conclusions: When a positive margin is accepted to preserve function, tissue that can be re-elevated, tolerates irradiation, and leaves residual disease accessible to inspection is a reasonable choice, although this remains untested here and the oncologic outcome is unknown.
SN - 2077-0383
ER -