6 things you should know about EMPD!

1. 

   What is EMPD?

   EMPD refers to the condition Extramammary Paget’s Disease. This is a rare and slow-growing skin condition that presents as a rash, in areas where the body is rich in apocrine sweat glands. EMPD is most common in the genital, perineal and axillary regions. 

2. How many types of EMPD are there?

There are 2 types of EMPD - primary and secondary. Primary EMPD develops in the skin on its own, while secondary EMPD occurs as a result of an underlying cancer.

It is important to distinguish primary and secondary EMPD as the treatment and outcome for both differs.

3. How does EMPD start?

EMPD is more common amongst those above the age of 50. It commonly appears in the genital, anal or armpit areas of men and women, but can appear anywhere on the body. Patients frequently indicate one or more of these symptoms: redness, itching, burning sensation, irritation, pain or soreness, scaly and/or crusty skin. Because of this, EMPD is often mistaken for other skin conditions like eczema or dermatitis, due to their similar appearances. 

4. How is EMPD confirmed?

EMPD can often be diagnosed via clinical examination. A skin biopsy is also performed to confirm the EMPD. Once diagnosed with EMPD, your doctor should also proceed to test for any underlying cancer. Some of these tests may includes gastroscopy, colonoscopy and CT scans.

5. How is EMPD treated?

The best treatment for EMPD often involves surgery, to remove the affected skin. If surgery is not feasible, other treatment options include: radiation therapy, chemotherapy, and topical treatments.

Surgery often involves a wide excision of the EMPD, followed by reconstruction. This procedure aims to removes all the cancer tissue, leaving a margin of healthy tissue. This approach is used to reduce the risk of recurrence, which can occur if the margins are not wide enough. As it is difficult to determine the extent of EMPD’s spread into underlying tissues, our surgeons opt to remove tissue beyond the visible margins to help reduce the chance of recurrence. Prior to surgery, our surgeons may also perform scouting or mapping biopsies to guide their approach.

Topical Treatments

Imiquimod is a topical cream that acts as an immune response to fight abnormal cell growth. However it does have some side effects, like pain, redness, swelling, itching, burning, sores, blisters, and tenderness.

Radiation Therapy

Radiation therapy is a treatment that uses doses of radiation to kill cancer cells and shrink tumors. Patients with EMPD who are treated with radiation can suffer from the side effects of radiation, that include fatigue, skin irritation and pain.

6. What should I do if I suspect I have EMPD?

If you suspect that you or your loved ones may have EMPD, it is important to seek medical advice from a surgical or medical oncologist to discuss your treatment options.