Background The recurrence rate of extramammary Paget disease after surgical resection is high due to the lesions' poorly delineated and unclear margins. Aims To evaluate the impact of non-invasive tumour margin detection via photodynamic diagnosis plus reflectance confocal microscopy on the surgical outcomes of patients with extramammary Paget disease. Methods Thirty-six patients with histopathologically confirmed primary extramammary Paget disease between January 2017 and June 2018 were included in this study. The skin lesion margins were preoperatively observed using the naked eye, photodynamic diagnosis, and reflectance confocal microscopy. An incision was made 0.5–2 cm from the outermost non-invasive detection marker line. The incision depth was more significant than the follicle level or the deepest level affected by the tumour in the biopsy specimens. After the skin lesions were removed, a pathological examination of the specimens was conducted to ensure clear margins to prevent tumour recurrence and metastases. Results A total of 166 good-quality tissue sections were selected from 36 patients. The tumour surfaces and deep margins were within the scope of resection. Six patients (6/36, 15.4%) experienced local recurrence 2–12 months postoperatively. One patient (1/36, 2.8%) had lymph node metastasis without local recurrence 36 months postoperatively and died 50 months postoperatively (1/36, 2.8%). Limitations This study is limited by the small patient population, especially the number of patients with mucous membrane involvement. Conclusion Using photodynamic diagnosis plus reflectance confocal microscopy to detect the margins of extramammary Paget disease lesions non-invasively reduces the postoperative tumour recurrence rate and is a valuable guide for tumour treatment.

中文翻译：

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光动力诊断与反射共焦显微镜相结合对乳房外佩吉特病患者肿瘤边缘检测和手术结果的影响

背景由于病灶轮廓不清、边缘不清晰，乳房外佩吉特病手术切除后复发率较高。 目标评估通过光动力诊断结合反射共聚焦显微镜进行无创肿瘤边缘检测对乳房外佩吉特病患者手术结果的影响。 方法本研究纳入了 2017 年 1 月至 2018 年 6 月期间经组织病理学确诊的 36 名原发性乳房外佩吉特病患者。术前采用肉眼、光动力诊断、反射共聚焦显微镜观察皮损边缘。距最外侧非侵入性检测标记线 0.5-2 厘米处切开一个切口。切口深度比活检标本中的卵泡水平或受肿瘤影响的最深水平更显着。皮损切除后，对标本进行病理检查，确保切缘清晰，防止肿瘤复发和转移。 结果从36名患者中总共选取了166份优质组织切片。肿瘤表面及深切缘均在切除范围内。6 名患者（6/36，15.4%）术后 2-12 个月出现局部复发。1例患者（1/36，2.8%）术后36个月出现淋巴结转移，无局部复发，术后50个月死亡（1/36，2.8%）。 局限性这项研究受到患者人数少的限制，特别是粘膜受累的患者数量。 结论利用光动力诊断结合反射共聚焦显微镜无创检测乳外佩吉特病病灶边缘，可降低术后肿瘤复发率，对肿瘤治疗具有重要指导意义。