A 72-year-old woman complains of anal itching and burning. Physical examination reveals an erythematous, scaly lesion, 3 cm in circumference, within the anal canal. The intersphincteric groove can not be appreciated in the area of the lesion. The remainder of the physical examination is normal. Appropriate initial management includes which of the following?
A. Acyclovir 200 mg QID for 10 days
B. Hydrocortisone cream 10% topically for 14 days
C. Incisional biopsy
D. Metronidazole 250 mg PO Q1D for 14 days
A. Acyclovir 200 mg QID for 10 days
B. Hydrocortisone cream 10% topically for 14 days
C. Incisional biopsy
D. Metronidazole 250 mg PO Q1D for 14 days
Ans.
C. Incisional biopsy
Extramammary Paget’s disease may be
found in the axilla and in the anogenital region, including the labia majora,
penis, scrotum, groin, pubic area, perineum, perianal region, thigh, and
buttock. Paget’s disease of the perianal area is a malignant neoplasm of the
intraepidermal portion of apocrine glands with or without associated dermal
involvement. Paget’s disease has a long preinvasive phase, but if untreated, an
invasive adenocarcinoma of the apocrine gland type develops. The disease is
more common in women than men, with the highest incidence in the seventh
decade.
Macroscopically, the lesion appears as an erythematous scaly or eczematoid
plaque-like lesion, similar to other benign perianal lesions, making clinical
diagnosis difficult. A definite diagnosis is made by biopsy, which shows
characteristic histologic appearance—large, pale, vacuolated cells with
hyperchromatic eccentric nuclei. The cells invariably contain acid
mucosubstances, an important feature in distinguishing this lesion from melanoma
and Bowen’s disease.
