Review of Gender Disparities in Initial Treatment Approaches for Genital Extramammary Paget Disease in the US
The following is a summary of “Sex differences in initial treatment for genital extramammary Paget disease in the United States: A systematic review,” published in the MARCH 2023 issue of Dermatology by Rastogi, et al.
Genital extramammary Paget disease (gEMPD) is a rare skin cancer that affects the genital area. Surgery is the standard treatment for gEMPD. For a study, researchers sought to investigate whether the treatment and outcomes of gEMPD differ by sex and US region.
The researchers reviewed all English-language studies on initial gEMPD treatment in Medline via PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov. At least 2 reviewers performed title and abstract review and data extraction. Surgical categories included total skinning procedures, partial skinning procedures, Mohs micrographic surgery (MMS), or unspecified surgery. Chi-squared tests of association were used for comparisons.
The study included a total of 60 studies comprising 302 (79.7%) female and 77 (20.3%) male patients. Women were most often initially recommended partial skinning procedures. In all, 74 (24.5%) women and 0 men underwent a total skinning procedure. Men were more likely to be offered MMS than women (40.3% vs. 1.9%, P < .0001), despite men having a significantly greater extent of disease involving the perineum and perianal skin (21.1% vs. 1.7%, P < .0001)—treatment recommendations varied by US region.
The study’s limitations included the fact that only 20 states were represented. In conclusion, the researchers found that women were more frequently offered total skinning procedures for gEMPD, while men were more frequently offered MMS. MMS offered less recurrence and morbidity than total skinning procedures and should be recommended equally to female and male patients with gEMPD. The results suggested that treatment recommendations should be based on the extent of the disease and not on the patient’s sex. It was important to consider the findings when developing clinical guidelines for managing gEMPD.