Deferred Lateral Margin Control in the Surgical Treatment of Genital Paget’s Disease and Lentiginous Vulvar Melanoma

<b>Background/Objectives:</b> Some skin tumors can extend beyond their clinical appearance. This presents an additional challenge, especially when the affected area is the genital region, which is more difficult for both the patient and the physician to access and monitor due to its location and anatomical characteristics. The treatment of these lesions is complex, and literature postulates Mohs surgery as the best therapeutic option. <b>Methods:</b> We describe our experience in two patients with the resection of vulvar lentiginous melanoma and genital extramammary Paget's disease, using a method of deferred lateral margin control in the surgical treatment. <b>Results:</b> The "spaghetti technique"(ST) initially removing a small strip from all lateral margins of the lesion, which is then closed directly while awaiting the paraffin histological result. In a second stage, the tumors within those margins are removed, and immediate reconstruction is performed. The final oncological and functional result was satisfactory, with no notable side effects. <b>Conclusions:</b> This method is suited for large, poorly defined superficial tumors in the genital, perineal, and perianal regions, where a frozen section study would be slow and burdensome for the patient and surgeon. The ST preserves healthy tissue and can be performed by any surgeon and pathologist without additional training, and is more comfortable for patients, avoiding prolonged open wounds during multiple steps of tumor excision.