Photodynamic treatment combined with liquid nitrogen cryotherapy in a large area of Extramammary Paget disease in an Female vulva

A 65 years female patient, long-term vulva pruritus, rash, repeated ulceration, was diagnosed with extramammary paget disease (EMPD) after biopsy. The physical examination showed large dark red spots in all the pubis and vulva, local ulcers and scars. 20%ALA photodynamic therapy was given twice in two weeks. Before PDT, Liquid nitrogen cryotherapy was performed, followed by 20% ALA immediately, incubating for 3 hours. Then 635nm LED red light cumulative irradiation 120J/cm2. Most of the lesions were improved after three treatments. However, after half a year, the recurrence of small pieces gradually appeared, and a new round of treatment was started 15 months after the first treatment, and also obtained good effect. This patient could not tolerate the treatment of external imiquimod, but could also tolerate the less frequent PDT combined with liquid nitrogen cryotherapy, which could be used as a good alternative treatment for the inoperable extramastia Paget disease.