PMC8042548_01
(a, b) Disease presentation before radiotherapy, which shows an erythematous patch to the penoscrotal region (white arrows).
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On local examination, an erythematous patch of 8 cm in the penoscrotal region was observed (Figure 1a and b).
(a) Skin and left scrotum involvement of the extramammary Paget's disease with an invasive component (hematoxylin-eosin staining, original magnification x 20), (b) the Paget's cells are positive for CAM 5.2 (original magnification   20).
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A skin biopsy revealed the invasion of Paget's cells into the dermis (Figure 2a and b).
Axial CT image with color overlays shows radiation dose distribution: (a) dose distribution of the 6 MeV electron beam plan using a uniform 10 mm thickness bolus, and (b) dose distribution of the 4 MV photon beam plan using a uniform 10 mm thickness bolus.
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RT was delivered conventionally (2.2 Gy/day, 5 fractions/week) using a single anterior 6 MeV electron beam (Figure 3a). The tumor response in the irradiation field was observed to be inhomogeneous at the completion of administration of 19.8 Gy in 9 fractions; thus, in a subsequent RT, an additional dose of 42 Gy at 2 Gy per fraction was delivered using a single anterior 4 MV photon beam using a uniform 10 mm thickness bolus (Figure 3b).
Macroscopic appearance of the patient's extramammary Paget's disease after radiotherapy.
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As of 6.5 years after the treatment, the tumor had not recurred and no severe late adverse events were observed (Figure 4).