Mohs micrographic surgery for extramammary Paget disease: A pooled analysis of individual patient data

Jung Min Bae, Yoon Young Choi, Heesu Kim, Byung Ho Oh, Mi Ryung Roh, Kyoungae Nam, Kee Yang Chung

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background: Extramammary Paget disease (EMPD) is a rare intraepithelial neoplasm of the skin characterized by ill-defined margins and high recurrence rates after wide local excision. Although Mohs micrographic surgery (MMS) has been proposed to decrease the rate of local recurrence, the efficacy of MMS for this condition has not yet been established. Objective: We sought to assess the efficacy of MMS for the treatment of EMPD. Methods: A comprehensive systematic review and individual patient data meta-analysis was performed including all available clinical studies and case reports with 5 or more subjects describing the use of MMS for EMPD. Results: Eight studies were identified and included in the current review: 3 retrospective studies and 5 case series. In all, 81 patients with 90 cases of MMS were included from these 8 studies. The overall recurrence rate for EMPD after MMS was 12.2% correlating with an estimated 5-year tumor-free rate of 83.6% by using Kaplan-Meier curve analysis. The treatment of EMPD with MMS resulted in significantly lower recurrence rates than wide local excision in this meta-analysis of 3 observational studies with comparators (odds ratio 0.20; 95% confidence interval 0.05-0.81). Limitations: Limitations include lack of controlled trials, small sample sizes in the included studies, and publication bias. Conclusion: The current evidence supports the efficacy of MMS in the treatment of EMPD. Further controlled clinical trials are needed.

Original languageEnglish
Pages (from-to)632-637
Number of pages6
JournalJournal of the American Academy of Dermatology
Volume68
Issue number4
DOIs
Publication statusPublished - 2013 Feb 11

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Extramammary Paget's Disease
Mohs Surgery
Recurrence
Meta-Analysis
Publication Bias
Carcinoma in Situ
Controlled Clinical Trials
Kaplan-Meier Estimate
Sample Size
Observational Studies
Therapeutics
Retrospective Studies
Odds Ratio
Confidence Intervals
Skin

All Science Journal Classification (ASJC) codes

  • Dermatology

Cite this

Bae, Jung Min ; Choi, Yoon Young ; Kim, Heesu ; Oh, Byung Ho ; Roh, Mi Ryung ; Nam, Kyoungae ; Chung, Kee Yang. / Mohs micrographic surgery for extramammary Paget disease : A pooled analysis of individual patient data. In: Journal of the American Academy of Dermatology. 2013 ; Vol. 68, No. 4. pp. 632-637.
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abstract = "Background: Extramammary Paget disease (EMPD) is a rare intraepithelial neoplasm of the skin characterized by ill-defined margins and high recurrence rates after wide local excision. Although Mohs micrographic surgery (MMS) has been proposed to decrease the rate of local recurrence, the efficacy of MMS for this condition has not yet been established. Objective: We sought to assess the efficacy of MMS for the treatment of EMPD. Methods: A comprehensive systematic review and individual patient data meta-analysis was performed including all available clinical studies and case reports with 5 or more subjects describing the use of MMS for EMPD. Results: Eight studies were identified and included in the current review: 3 retrospective studies and 5 case series. In all, 81 patients with 90 cases of MMS were included from these 8 studies. The overall recurrence rate for EMPD after MMS was 12.2{\%} correlating with an estimated 5-year tumor-free rate of 83.6{\%} by using Kaplan-Meier curve analysis. The treatment of EMPD with MMS resulted in significantly lower recurrence rates than wide local excision in this meta-analysis of 3 observational studies with comparators (odds ratio 0.20; 95{\%} confidence interval 0.05-0.81). Limitations: Limitations include lack of controlled trials, small sample sizes in the included studies, and publication bias. Conclusion: The current evidence supports the efficacy of MMS in the treatment of EMPD. Further controlled clinical trials are needed.",
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Mohs micrographic surgery for extramammary Paget disease : A pooled analysis of individual patient data. / Bae, Jung Min; Choi, Yoon Young; Kim, Heesu; Oh, Byung Ho; Roh, Mi Ryung; Nam, Kyoungae; Chung, Kee Yang.

In: Journal of the American Academy of Dermatology, Vol. 68, No. 4, 11.02.2013, p. 632-637.

Research output: Contribution to journalArticle

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T1 - Mohs micrographic surgery for extramammary Paget disease

T2 - A pooled analysis of individual patient data

AU - Bae, Jung Min

AU - Choi, Yoon Young

AU - Kim, Heesu

AU - Oh, Byung Ho

AU - Roh, Mi Ryung

AU - Nam, Kyoungae

AU - Chung, Kee Yang

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N2 - Background: Extramammary Paget disease (EMPD) is a rare intraepithelial neoplasm of the skin characterized by ill-defined margins and high recurrence rates after wide local excision. Although Mohs micrographic surgery (MMS) has been proposed to decrease the rate of local recurrence, the efficacy of MMS for this condition has not yet been established. Objective: We sought to assess the efficacy of MMS for the treatment of EMPD. Methods: A comprehensive systematic review and individual patient data meta-analysis was performed including all available clinical studies and case reports with 5 or more subjects describing the use of MMS for EMPD. Results: Eight studies were identified and included in the current review: 3 retrospective studies and 5 case series. In all, 81 patients with 90 cases of MMS were included from these 8 studies. The overall recurrence rate for EMPD after MMS was 12.2% correlating with an estimated 5-year tumor-free rate of 83.6% by using Kaplan-Meier curve analysis. The treatment of EMPD with MMS resulted in significantly lower recurrence rates than wide local excision in this meta-analysis of 3 observational studies with comparators (odds ratio 0.20; 95% confidence interval 0.05-0.81). Limitations: Limitations include lack of controlled trials, small sample sizes in the included studies, and publication bias. Conclusion: The current evidence supports the efficacy of MMS in the treatment of EMPD. Further controlled clinical trials are needed.

AB - Background: Extramammary Paget disease (EMPD) is a rare intraepithelial neoplasm of the skin characterized by ill-defined margins and high recurrence rates after wide local excision. Although Mohs micrographic surgery (MMS) has been proposed to decrease the rate of local recurrence, the efficacy of MMS for this condition has not yet been established. Objective: We sought to assess the efficacy of MMS for the treatment of EMPD. Methods: A comprehensive systematic review and individual patient data meta-analysis was performed including all available clinical studies and case reports with 5 or more subjects describing the use of MMS for EMPD. Results: Eight studies were identified and included in the current review: 3 retrospective studies and 5 case series. In all, 81 patients with 90 cases of MMS were included from these 8 studies. The overall recurrence rate for EMPD after MMS was 12.2% correlating with an estimated 5-year tumor-free rate of 83.6% by using Kaplan-Meier curve analysis. The treatment of EMPD with MMS resulted in significantly lower recurrence rates than wide local excision in this meta-analysis of 3 observational studies with comparators (odds ratio 0.20; 95% confidence interval 0.05-0.81). Limitations: Limitations include lack of controlled trials, small sample sizes in the included studies, and publication bias. Conclusion: The current evidence supports the efficacy of MMS in the treatment of EMPD. Further controlled clinical trials are needed.

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