Staged excision and split-thickness skin graft for circumferential perianal Paget's disease

PURPOSE: This study was designed to describe a surgical technique for the t reatment of circumferential Pager's disease. METHODS: A search of our compu terized patient registry was undertaken, and case records for those patient s with perianal Pager's disease were systematically reviewed. RESULTS: Betw een July 1993 and October 1998, four patients with perianal Paget's disease were identified. circumferential lesions were identified in three of the f our patients. Wide local excision was considered the procedure of choice. A ll patients underwent a two-staged excision using split-thickness skin graf t reconstruction A similar second stage was performed six to eight weeks la ter, the other half of the circumference was excised and grafted. No patien t had a protective stoma. Graft survival was 100 percent for two patients ( four operations) and 80 percent and 70 percent for the other two patients ( two operations). The remaining surface healed successfully by secondary int ention. In one patient, residual disease was positive at one margin, and a third local excision and split-thickness skin graft was performed. Hospital stay ranged from five to nine days for each procedure. There were no major complications; one patient developed a mild anal stenosis three months aft er the second procedure and was successfully medically treated. CONCLUSIONS : Staged excision and split-thickness skin graft is a viable option for the treatment of circumferential perianal lesions. It carries a minimal morbid ity and no observed mortality, the functional result is good, and it is tec hnically simple compared with myocutaneous grafts. Moreover, a stoma is not required.