{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:05:01Z","timestamp":1787029501485,"version":"build-2736575974"},"reference-count":10,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: Extramammary Paget disease (EMPD) is a rare cutaneous adenocarcinoma that frequently involves apocrine-rich regions and may extend beyond clinically apparent margins through adnexal structures. Surgical excision remains the standard of care; however, management can be challenging in elderly patients and in anatomically sensitive areas such as the scrotum, where morbidity and functional impairment are significant concerns. Despite increasing use of radiation-based therapies, optimal superficial radiation therapy (SRT) parameters, particularly with respect to depth of penetration, remain poorly standardized. Case Presentation: An 88-year-old male with a history of melanoma, non-melanoma skin cancer, and remote prostate cancer presented with biopsy-proven EMPD involving the scrotum and perineum. Imaging demonstrated no evidence of underlying or metastatic malignancy. Given lesion size (9 \u00d7 4 cm), anatomic location, and patient preference to avoid surgery, SRT was selected. The patient underwent treatment with 70 kV energy, delivering a total dose of 5440 cGy in 17 fractions (320 cGy per fraction) administered twice weekly. Energy selection was guided by the known propensity of EMPD for adnexal extension, with the aim of improving treatment coverage of potential subclinical disease. Conclusions: This case highlights the importance of incorporating tumor depth and adnexal involvement into treatment planning for EMPD. Depth-guided SRT may represent a viable non-surgical management strategy in carefully selected patients, particularly when surgical morbidity is a concern. These findings support a more individualized, mechanism-based approach to optimizing radiation therapy in cutaneous malignancies.<\/jats:p>","DOI":"10.3390\/reports9020163","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T15:02:27Z","timestamp":1779375747000},"page":"163","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Non-Surgical Management of Scrotal Extramammary Paget Disease: A Case Report of a Cutaneous Malignancy Treated with Depth-Guided Superficial Radiation Therapy"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-9695-4485","authenticated-orcid":false,"given":"Douglas Jaxon","family":"Vadner","sequence":"first","affiliation":[{"name":"Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sidney","family":"Smith","sequence":"additional","affiliation":[{"name":"Georgia Skin and Cancer Clinic, Savannah, GA 30415, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1001\/jamaoncol.2021.7148","article-title":"Evidence-based clinical practice guidelines for extramammary Paget disease","volume":"8","author":"Kibbi","year":"2022","journal-title":"JAMA Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.hoc.2018.09.003","article-title":"Extramammary Paget Disease","volume":"33","author":"Asel","year":"2019","journal-title":"Hematol. Clin. N. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"101773","DOI":"10.1016\/j.cpsurg.2025.101773","article-title":"Extramammary Paget\u2019s disease: An analysis of plastic surgical treatment, clinical and histopathological characteristics, and prognosis","volume":"69","author":"Wang","year":"2025","journal-title":"Curr. Probl. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1097\/IGC.0000000000001189","article-title":"Extramammary Paget disease of the vulva: A case series examining treatment, recurrence, and malignant transformation","volume":"28","author":"Nitecki","year":"2018","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1097\/DAD.0b013e3181b71481","article-title":"The role of immunohistochemistry in discriminating primary from secondary extramammary Paget disease","volume":"32","author":"Perrotto","year":"2010","journal-title":"Am. J. Dermatopathol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/PAP.0b013e318202eba5","article-title":"Lesions of anogenital mammary-like glands: An update","volume":"18","author":"Kazakov","year":"2011","journal-title":"Adv. Anat. Pathol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1097\/DAD.0000000000000552","article-title":"Depth and patterns of adnexal involvement in primary extramammary (anogenital) Paget disease: A study of 178 lesions from 146 patients: A study of 178 lesions from 146 patients","volume":"38","author":"Konstantinova","year":"2016","journal-title":"Am. J. Dermatopathol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"365","DOI":"10.4143\/crt.2005.37.6.365","article-title":"The role of radiation therapy for the extramammary paget\u2019s disease of the vulva; experience of 3 cases","volume":"37","author":"Son","year":"2005","journal-title":"Cancer Res. Treat."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1093\/annonc\/mdt478","article-title":"Radiation therapy for extramammary Paget\u2019s disease: Treatment outcomes and prognostic factors","volume":"25","author":"Hata","year":"2014","journal-title":"Ann. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"250","DOI":"10.4103\/ds.ds_18_20","article-title":"Radiotherapy for invasive extramammary Paget\u2019s disease: A case report","volume":"38","author":"Lin","year":"2020","journal-title":"Dermatol. Sin."}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/2\/163\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T04:25:47Z","timestamp":1779510347000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/2\/163"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,21]]},"references-count":10,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["reports9020163"],"URL":"https:\/\/doi.org\/10.3390\/reports9020163","relation":{},"ISSN":["2571-841X"],"issn-type":[{"value":"2571-841X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,21]]}}}