Aminolevulinic Acid Photodynamic Therapy for Extensive Genital Extramammary Paget Disease in Older Patients: A Retrospective Clinical Case Series.

BACKGROUND: Extramammary Paget disease (EMPD) involving the genital and anogenital region is difficult to manage when lesions are extensive, chronic, or located across functionally sensitive sites. In older patients with diabetes, cardiovascular disease, or advanced local involvement, wide excision may lead to considerable perioperative burden, delayed healing, and anatomical impairment. OBJECTIVE: To describe the short-term clinical outcomes and symptom relief associated with aminolevulinic acid photodynamic therapy (ALA-PDT) in older patients with extensive EMPD who were unsuitable for disfiguring surgery or declined surgical treatment. METHODS: We retrospectively reviewed three histologically confirmed EMPD cases affecting the mons pubis, penile root or foreskin, scrotum, inguinal region, and adjacent proximal thigh. All patients received lesion preparation by debridement followed by topical 10% ALA-PDT using a standardized illumination regimen. RESULTS: At the 3-month evaluation, erosive and exudative areas had re-epithelialized, and nodular lesions showed marked reduction or flattening. Pruritus and local pain improved rapidly and had resolved within 2 weeks after treatment initiation. Mild transient erythema was the only treatment-related reaction. No clinically apparent regrowth or progression was observed during the 12-month clinical and dermoscopic follow-up. CONCLUSION: In this small retrospective series, ALA-PDT was associated with short-term clinical control and palliative benefit in older patients with extensive genital EMPD, while preserving genital anatomy without creating large surgical defects. These preliminary findings support further evaluation of optimized PDT-based conservative strategies for difficult-to-treat EMPD.