Abstract
Extramammary Paget's disease (EMPD) is a rare and difficult-to-treat skin cancer found in apocrine-rich body regions including the genital, perianal, and axillary skin. Wide local excision (WLE), which has been the standard of care, demonstrates high rates of local recurrence due to the tendency of EMPD to exhibit wide subclinical spread. Mohs micrographic surgery (MMS) has been shown to have lower local recurrence rates compared with WLE but higher than for more common forms of skin cancer. Techniques to preoperatively delineate clinical tumor margins or improve the accuracy of histopathological tumor identification have been reported and show promise to reduce local recurrence rates. The combination of surgical and non-surgical therapeutic options has also been encouraging, although data is limited. The development of an optimized surgical treatment strategy could improve surgical outcomes by reducing local recurrence rates and patient morbidity.