Is that groin rash cancer ??

                                  Is that groin rash cancer ??


           A few years ago one of my male patients presented with a groin rash of

several months duration which was unresponsive to various topical antifungals and

topical corticosteroids prescribed by his health care practitioner.

            The rash was red and scaly encompassing both his groin and extending

to his scrotal areas. There was associated itching and burning at times.

           The most important clue here was the fact that the rash had been

chronically unresponsive to the above measures.

            And,I immediately suspected a condition called extramammary Paget's

disease (EMPD) which fortunately is  a rare cancerous condition of apocrine-

gland bearing sites.

            Two types of EMPD have been described: the primary type thought to arise

from a stem cell within genital skin and not associated with an underlying internal

malignancy involving the rectum and/or other internal body areas. However, it is

still a carcinoma of the skin and needs to be treated.

           Secondary EMPD  is the more dangerous type since it is associated with

an underlying adnexal  adenocarcinoma or an  underlying visceral (internal)

cancer and is the same as mammary Paget's disease of the nipple.

          I referred my patient to a general surgeon for a deep excisional skin

biopsy which confirmed my clinical suspicions. The presence of a cellular

protein called cytokeratin 20 helps to differentiate between the primary and

secondary types of EMPD.

         In addition, the presence of a gene called HER-2  in the biopsy specimen

may indicate a high risk for spread to lymph nodes and the need to follow this

patient very diligently.

          EMPD most frequently involves the vulva in women,the perianal area,perineum,

scrotum,penis, and armpits. Treatment includes wide surgical excision,radiation

therapy and several topical agents.