5-aminolevulinic acid (5-ALA) fluorescence-guided Mohs surgery resection of penile-scrotal extramammary Paget's disease

This report aims to evaluate the usefulness of 5-aminolevulinic acid (5-ALA) fluorescence-guided Mohs surgery resection of penile-scrotal extramammary Paget's disease. 5 patients underwent surgical resection of penile-scrotal Paget's disease. All patients were coated with 5-ALA (concentration 20%) for 3 hours throughout the scrotum and the visible area of the lesion plus a 2 cm margin. 5-ALA fluorescence was visualized under ultraviolet (UV) light. The extent of resection was evaluated by histology. If the fluorescence-positive punctate lesions were found outside the resection area, we removed the lesions for pathologic examination. Lesions in the blue light turns red after irradiation, the fluorescence-guided surgery delineated area is less than the naked eye, intraoperative frozen prompted negative margins. A total of 31 scattered lesions were found. After biopsy prompted pathology four were positive. In conclusion, 5-ALA fluorescence-guided minimum area can be completely removed in penile-scrotal Paget's lesions, and it can detect distant scattered lesions.