1126P - The role of sentinel lymph node biopsy in the management of invasive extramammary Paget's disease: multi-center, retrospective study of 151 patients

Date 28 September 2014
Event ESMO 2014
Session Poster Display session
Topics Melanoma and other Skin Tumours
Surgery and/or Radiotherapy of Cancer
Presenter Yasuhiro Fujisawa
Citation Annals of Oncology (2014) 25 (suppl_4): iv374-iv393. 10.1093/annonc/mdu344
Authors Y. Fujisawa1, K. Yoshino2, K. Ohara3, T. Kadono4, T. Takenouchi5, N. Hatta6, H. Uhara7, Y. Kiyohara8, Y. Murata9, S. Matsushita10, T. Hayashi11
  • 1Dermatology, University of Tsukuba, 3058575 - Tsukuba/JP
  • 2Dermatology, Tokyo Metropolitan Cancer Center Komagome Hospital, Tokyo/JP
  • 3Dermatology, Toranomon Hospital, Tokyo/JP
  • 4Dermatology, University of Tokyo, Tokyo/JP
  • 5Dermatology, Niigata Cancer Center, Niigata/JP
  • 6Dermatology, Toyama Chuo Hospital, Toyama/JP
  • 7Dermatology, University of Shinshu, Nagano/JP
  • 8Dermatology Division, Shizuoka Cancer Center, 411-8777 - Nagaizumi, Shizuoka/JP
  • 9Dermatology, Hyogo Cancer Center, Akashi/JP
  • 10Dermatology, University of Kagoshima, Kagoshima/JP
  • 11Plastic Surgery, University of Hokkaido, Sapporo/JP



Although most of the extramammary Paget's disease (EMPD) presents as carcinoma in situ, we sometimes encounter patients with invasive EMPD (iEMPD) with lymph node metastasis which may develop distant metastasis. Sentinel lymph node biopsy (SLNB) is conducted in various cancers, however, there is no large study that assessed its role in iEMPD.The aim of this study is to investigate the role of SLNB in patients with iEMPD.


We retrospectively collected 151 iEMPD patients from 11 institutes in Japan treated from 1998 to 2012. Of those, 107 patients had no lymphadenopathy and received SLNB. Other 44 patients had lymphadenopathy and their LN status was determined pathologically. All the patients received curative surgery of the primary tumor and none of them had distant metastasis.


Sixteen patients (15%) had SLN metastasis. Patients with SLN metastases had statistically deeper invasion level, nodular invasion pattern, and vascular/lymphatic invasion. Multivariate analysis revealed only vascular/lymphatic invasion was associated with SLN positivity (p = 0.0015). Tumor invasion level and nodular infiltrate pattern showed tendency to associate with SLN positivity (p = 0.093 and p = 0.083, respectively). Notably, there was no survival disadvantage of SLN positive patients over SLN negative patients (p = 0.71). On the other hand, 34 of the 44 patients (77%) with lymphadenopathy had LN metastasis and showed tendency to have worse survival compared with SLN positive patients (p = 0.07).


There was no survival disadvantage of SLN positive patients despite of having deeper invasion and frequent vascular/lymphatic invasion. Our results raise the possibility that SLNB and following LN dissection improved survival of patients with micrometastasis. Therefore, SLNB should be considered for iEMPD if lymphadenopathy is not apparent.


All authors have declared no conflicts of interest.