Practice Patterns in Extramammary Paget's Disease

ABSTRACT Background In patients with Extramammary Paget's Disease (EMPD), a rare intraepithelial adenocarcinoma, wide local excision (WLE) has historically been the standard of treatment despite high rates of positive margins and recurrence. Mohs micrographic surgery (MMS) has demonstrated superior outcomes, yet practice patterns vary due to limited consensus guidelines. Objectives To evaluate whether referring and treating specialty influences surgical management patterns in patients with EMPD at a single academic center. Methods We conducted a retrospective chart review of 23 patients with biopsy‐confirmed EMPD at a single academic center between 2009 and 2025. Collected variables included lesion site, referring specialty, treating specialty, treatment modality, and outcomes. Results Lesion sites included the vulva, scrotum, groin/perineum, and abdomen. Nineteen patients (82.6%) underwent surgery with either WLE or MMS. Among surgically managed vulvar cases, all were treated by gynecologic oncology (Gyn Onc) or obstetrics‐gynecology (OBGYN) specialists, while dermatologists exclusively performed MMS and managed the only non‐genital lesion. Treatment modality was significantly associated with both treating specialty ( p  = 0.001) and referring specialty ( p  = 0.0041). No patients referred by Gyn Onc or OBGYN received MMS. Conclusions These findings suggest that EMPD management may be influenced by specialty‐driven practice patterns rather than evidence‐based data, potentially contributing to higher recurrence risk. Limited access to MMS, well‐established referral networks, and the absence of formal treatment guidelines may explain these discrepancies. A multidisciplinary approach, standardized referral protocols, and improved awareness of MMS outcomes are needed to optimize patient care.