确定乳房外Paget病肿瘤手术切缘的研究进展

Determination of surgical margins in extramammary Paget＇s disease

乳房外Paget病是少见的上皮来源的皮肤恶性肿瘤，好发于肛门及外生殖器等顶泌汗腺分布区域。乳房外Paget病通常表现为边界不规则的红斑、鳞屑、渗出或湿疹样斑块，肿瘤组织难以切除干净，并具有较高的复发率。乳房外Paget病的治疗尚无金标准，但手术切除是其首选的常规治疗，因此，如何确定适当的手术切缘是关键。目前已经提出了获得肿瘤阴性边缘的多种方法，以尽量减少手术所致的组织缺损，减少创伤，提高生活质量。这些方法包括病变可见边界切除、术前定位活检与术中冰冻切片、Mohs显微描记外科手术、免疫组化、影像学及荧光法等。

Extramammary Paget′s disease （EMPD）, a rare cutaneous malignant neoplasm derived from the epithelium, mostly occurs in apocrine gland？bearing regions such as the anus and genitalia. EMPD usually manifests as erythematous, scaling, exudating or eczematous plaques with irregular borders. It is difficult to completely remove EMPD lesions, and recurrence is frequent. Although there is no golden standard for the treatment of EMPD, surgical resection is the first？choice conventional treatment. Therefore, determining appropriate surgical margins is the key for its surgical treatment. Multiple methods have been proposed to attain tumor？free （negative） surgical margins, so as to minimize tissue defects caused by surgical procedures, reduce injury and improve the quality of life. These methods include excision of visible lesion borders, preoperative mapping biopsy and intraoperative frozen biopsy, Mohs micrographic surgery, immunohistochemical staining, radiological examination, fluorescence examination, and so on.