Sex differences in initial treatment for genital extramammary Paget disease in the United States: A systematic review - 24/02/23
Abstract |
Background |
Surgery is the standard treatment for genital extramammary Paget disease (gEMPD).
Objective |
To determine if gEMPD treatments and outcomes differ by sex and US region.
Methods |
A systematic review was performed of all English-language studies on initial gEMPD treatment in Medline via PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov. At least 2 reviewers performed title and abstract review and data extraction. Surgical categories included total skinning procedures, partial skinning procedures, Mohs micrographic surgery (MMS), or unspecified surgery. Chi-squared tests of association were used for comparisons.
Results |
A total of 60 studies comprising 302 (79.7%) female and 77 (20.3%) male patients met criteria. Women were most often initially recommended partial skinning procedures. In all, 74 (24.5%) women and 0 men underwent a total skinning procedure. Men were more likely to be offered MMS than women (40.3% vs 1.9%, P < .0001), despite men having a significantly greater extent of disease involving the perineum and perianal skin (21.1% vs 1.7%, P < .0001). Treatment recommendations varied by US region.
Limitations |
Only 20 states were represented.
Conclusion |
Women are more frequently offered total skinning procedures for gEMPD while men are more frequently offered MMS. MMS offers less recurrence and morbidity than total skinning procedures and should be recommended equally to both female and male patients with gEMPD.
Le texte complet de cet article est disponible en PDF.Key words : adenocarcinoma in situ, extramammary Paget’s disease, genital disease, intraepithelial adenocarcinoma, Mohs micrographic surgery, sex differences, vulvar disease
Abbreviations used : EMPD, gEMPD, MMS
Plan
| Funding sources: None. |
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| Conflicts of interest: None disclosed. |
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| Reprints not available from the authors. |
Vol 88 - N° 3
P. 577-586 - mars 2023 Retour au numéro
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