Diagnostic delays and nuanced surgical management in perianal Paget's disease: a case report and review of current literature.

Perianal Paget's disease is an uncommon and difficult to treat disease due to the high risk of positive margin at resection and high risk for recurrence. It can arise as a primary tumor or secondary to underlying pelvic visceral malignancy and is often initially misdiagnosed as an inflammatory perianal rash until proper pathologic diagnosis has been confirmed. We present the case of a 76-year-old woman who presented with 2 years of a perianal rash unsuccessfully treated with various topical interventions. Eventually, a biopsy was performed revealing extramammary Paget's disease and she underwent surgical excision of the perianal lesion. Operative pathology unfortunately exhibited positive margins and we detail the multidisciplinary discussion of further management options in this complicated clinical dilemma. This case highlights the importance of early recognition of this disease and a multidisciplinary approach to its treatment.