Inguinal area rash
A 67-year-old man asked his family physician (FP) to look at a persistent pruritic rash in the inguinal area that had been bothering him for some time. For a year, he’d been treated with topical and oral antifungal agents for presumed tinea cruris. A potassium hydroxide prep was negative. Screening for diabetes showed a normal fasting blood sugar and glycosylated hemoglobin.
What's your diagnosis?
Concerned that this could be some type of malignancy, the FP performed a 4 mm punch biopsy and the pathology report came back as Paget’s disease.
Extramammary Paget’s disease should be considered in any patient with chronic dermatitis of the groin, vulva, scrotal, or perianal area. Patients with Paget’s disease of the external genitalia often present with nonresolving eczematous lesions in the groin, genitalia, perineum, or perianal area. Pruritus occurs in approximately 70% of patients. Patients may also experience burning, pain, or no symptoms other than the lesion.
The risk of recurrence is higher in men than women. The recurrence rate of primary tumors after standard surgical excision is 30% to 60%. The rate after excision with Mohs micrographic surgery is 8% to 26%. In this case, the FP sent the patient for Mohs surgery to minimize the risk of recurrence.
Photo courtesy of Anna Saucedo, MD. Text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux EJ. Paget disease of the external genitalia. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:514-518.
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