Four vulvectomy specimens from patients with vulvar Paget's disease were studied by means of subserial total sectioning. In each case, the extent of histologically demonstrable disease was far greater than that of the visible lesion, the outline of the involved area was highly irregular, and multiple foci of disease were present. The implications of the findings for treatment selection, intraoperative management, and histogenesis are discussed.
Cancer 46590-594, 1980.
N THE COURSE of previous s t ~d i e s ~, ~ of vulvar Paget's I disease, it was noted that local recurrence is frequent after seemingly adequate surgical excision. Thirty-eight percent of reported patients experienced one or more recurrences. In over half, the recurrence appeared within 18 months after initial treatment. One possible reason for this, it was hypothesized, might be that the area of actual involvement in Paget's disease is greater than the visible lesion and is also irregular in outline.
If this were the case, it would be expected that incomplete excision would be frequent and the histologic evaluation of surgical margins would often be misleading.
To test this hypothesis, four consecutive vulvectomy specimens from patients with Paget's disease were subjected to total sectioning, and the extent of histologically recognizable disease in each specimen was mapped.
Materials and Methods
The 4 patients from whom the specimens were obtained were referred to the hospital between September 1976 and March 1978. None had had any prior treatment other than topical antipruritic or antifungal ointments or lotions. In each case, the diagnosis had been established by means of biopsy examination, but no