Surgical strategy and outcomes of penoscrotal Paget's disease: A large retrospective cohort study in a Chinese tertiary center.

BACKGROUND

Penoscrotal Paget's disease (PPD) is a rare malignant skin tumor, and consensus on reconstruction, treatment strategies, and prognosis remains elusive. We aimed to elucidate the clinical features, surgical outcomes, and prognosis, proposing a tailored Perineal Reconstruction (PR) strategy.

METHODS

We conducted a retrospective cohort study using pathologically confirmed 233 PPD cases from a large tertiary hospital pathology registry between May 2004 and February 2021. Clinical features, surgical treatment patterns, sexual function, and prognosis were analyzed. Kaplan-Meier analysis, univariate and multivariate Cox regression were performed to identify prognostic factors.

RESULTS

PR strategy-based reconstruction was applied on all postsurgical defects. Kaplan-Meier analysis indicated worse disease free-survival (DFS) in the high-PR score (≥4) group compared to the low-PR score (≤3) group. Age, tumor thickness, and lymph node invasion emerged as independent predictors of overall survival (OS).

CONCLUSIONS

Early evaluation and intervention are crucial to prevent vertical and lymph node invasion. Wide local excision provides low recurrence, high overall survival rates, and acceptable sexual function. The PR strategy serves as a promising approach to assess lesions, guide reconstruction, and predict prognosis, potentially improving treatment and management of this rare malignancy.